Augmentative and alternative communication (AAC) consists of any method of communicating that supplements or completely substitutes oral and/or written language when it is impaired. Therefore, it enables children with complex communication needs to develop their full communicative potential. However, despite the many benefits of AAC and its widespread use, several review studies have underscored the problems faced by parents and children who use AAC in their daily lives. The general objective of this systematic review and qualitative meta-synthesis is to provide a complete overview of parents’ experiences and perceptions with their children’s use of AAC. Specifically, it aimed to identify common themes and subthemes of interest and to analyze the research quality of the selected studies. An exhaustive literature search was carried out using different electronic databases. Nineteen studies were included, involving 297 parents. A thematic synthesis was undertaken. Three main themes and nine subthemes were identified: service support ; characteristics of AAC systems ; and integration of AAC in daily life . Findings raise a need for more services that support children with complex communication deficits in different contexts, more functional use of AAC systems at school and in real-world situations, as well as service assistance over an extended time period. Communication skills are essential in the adaptive development of individuals, especially during childhood, and are often considered a major factor that positively influences short- and long-term outcomes . In consPeople with complex communication needs are a heterogeneous group including individuals with a wide range of disabilities as Autism Spectrum Disorder, intellectual disability, communication disorders, cerebral palsy, Fragile X, Angelman syndrome, Down syndrome, Rett syndrome or others.The prevalence of individuals with communication and language problems is increasing due in part to the growing incidence of ASD . MoreoveAAC is an umbrella term that encompasses all the methods and means of communication intended for helping/replacing speaking and/or writing when these are being affected. It includes a wide range of unaided and aided strategies and low or high techniques to assist the communication and participation of individuals with complex communication needs. Unaided systems refer to manual signs and gestures to support the communicative interaction. Aided communication modes require additional materials or devices outside of the speaker’s body and are subdivided into high- and low-technology. Low-technology systems or devices encompass communication books or boards (non-battery powered), written words on paper, line drawings, symbols on a ring or in a notebook, photographs, and pictograms such as the Picture Exchange Communication System . High-tDespite the enormous potential of AAC and the exponential increase in aided high technology systems, several review studies have highlighted the problems faced by parents and children who use AAC in their daily lives. As a result, some families with children and adolescents with complex communication needs end up abandoning or under-using AAC systems. A study by Moorcroft et al.  evidenceThere is little research that has synthesized parental experiences with augmentative and alternative communication. Moorcroft et al.  identifiExamination of the facilitators and barriers that may exist for parents to the provision and children’s use of AAC systems could highlight some important considerations for the effectiveness, accessibility, and maintenance of AAC systems. However, previous reviews have been limited by methodological constraints or for not considering parents’ perceptions about their children’s use of AAC. Qualitatively exploring the perceptions and experiences of parents about AAC has the potential to identify the key factors that contribute to supporting children with complex communication needs and their families. Therefore, the current review examines the perceptions and experiences of parents with their children’s use of AAC systems.(a)-What do families think about the support they receive during the process of AAC implementation? -What are the characteristics of the AAC that constitute barriers and facilitations to their use ? What are the reasons that lead some families to abandon the use of AAC? -What challenges are posed by the different contexts of use of the AAC?To provide a complete overview of parents’ experiences and perceptions regarding the use of AAC by their children with complex communication needs in order to identify, integrate, and interpret common themes which may contribute to improving professional practice:(b)To find out the quality of the investigations about family’s experiences and opinions on the use of AAC by their children, with the aim of determining the rigor of the research base to date, and the aspects needed to be overcome in future studies.Specifically, the present systematic review and meta-synthesis tries to respond to the following objectives and research questions:The findings of this qualitative metasynthesis may be used to help identify ways to improve the implementation of AAC to optimize language and communication skills for children with complex communication needs. It has important implications for stakeholders  in understanding AAC systems and providing support to children with communication difficulties and their families. A systematic literature search was undertaken from November 2021 to December 2021 using the following electronic databases: Pubmed, CINAHL, PsyINFO, Embase, Web of Science Core Collection, Education Resources Information Centre (ERIC), Scopus, gray literature databases , and generic web searches (Google Scholar). The identified studies were included using the SPIDER tool  . TherefoThis review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines , see FigThe first and second authors independently searched the literature and screened all titles and abstracts. Agreement between reviewers after screening the potential studies was high (kappa = 0.95). If a full text met all the predefined eligibility criteria, it was included in the review. Any uncertainty on meeting the eligibility criteria was resolved by consensus among the research team.Papers were included if they: (i) were written in English, (ii) used qualitative methods and/or mixed methods, as long as it was possible to extract the qualitative data collection, narrative analysis , (iii) involved parents or caregivers of children (aged 2–17 years) users of augmentative and/or alternative communication systems, with any type of speech, language, or communication difficulty, (iv) focused on parents’ views, experiences or perceptions of the use of augmentative and/or alternative communication, (v) were published in a peer-reviewed journal, and (vi) were published from 2012 to January 2022. This time frame was selected following Moorcroft , as in tPapers were excluded if: (i) studies did not include the experiences and perceptions of parents, (ii) had a literacy focus , (iii) did not report qualitative outcomes, (iv) did not employ AAC systems, or (v) parents or caregivers of adults were involved.Considering the large number definitions of AAC offered in the literature, we adopted the definition by Crowe et al. , for a sThe quality of included studies in this review was appraised using the Program Qualitative Checklist , 2018), a strong quality assessment tool for assessing qualitative research. The ten items on the CASP checklist are classified in a numerical outcome , Yes = 1), with a maximum total score of 10. Following Butler et al. , we cateIn order to analyze the data, a qualitative methodology was used, as this is the method employed in the body of work on which this metasynthesis is based, as well as one of the articles’ inclusion criteria. The thematic synthesis was chosen as the qualitative evidence synthesis method for its usefulness to provide information . The curThe synthesis followed three stages that were applied as follows:The study’s findings were extracted and summarized according to the research questions. As Thomas and Harden 2008) [08 [20] sThe descriptive themes that emerged from the inductive analysis of study findings were used to answer the research questions that had temporarily been put to one side: the family’s opinions about the supports received during the process of AAC implementation; the AAC characteristics that constitute barriers and facilitators to their use; and the challenges posed by the different contexts of use of the AAC. This process resulted in the generation of three main themes, from which different conclusions were extracted aiming to contribute to professional practice.The search yielded 1398 articles distributed over time as shown in A total of 19 studies were identified for inclusion in the current review as summarized in The 19 studies summarized the perspectives of 297 parents, mainly mothers. The studies included 293 children and adolescents aged between 3 and 17 years old with diverse diagnoses: 67 children diagnosed with ASD, 39 with cerebral palsy, 15 with intellectual disability, 7 with Down syndrome, 123 with Angelman syndrome, 4 with Fragile X syndrome, 24 with language/communication disorders, 13 others (no specified diagnoses), and 1 study involved a mother of a child who was deaf/hard of hearing. The majority of studies came from the United States , followed by Australia , and Sweden . There was one study from the United Kingdom, Canada, Ireland, Sri Lanka, Korea, Kenya, and Malaysia. Two of the studies from the United States involved Spanish- and Russian-speaking parents. Four studies were from monolingual families and the participants of the other studies were from a mixture of multilingual and ethnic backgrounds, although most investigations were unclear on this aspect.As regards the modalities of AAC systems, participants used multimodal AAC systems according to Crowe et al.’s  classifiThe inductive analysis of the different topics addressed in the selected studies led us to determine three broad themes and ten subthemes outlining parental experiences and perceptions of AAC for children with communication difficulties. The three main themes identified concerned service support, the characteristics of the AAC systems, and the integration of AAC into daily life. Inside each theme, different subthemes could be recognized. Regarding parents’ perceptions on service support, four subthemes were identified: parents’ support and training, accessibility, service providers, and coordination. With respect to the characteristics of AAC systems, parents’ contributions could be categorized into usability and acceptability, features, and cost and funding. Finally, issues related to the integration of AAC in daily life were organized into the different environments of AAC use: family, school, and social and community contexts. These key findings, organized into themes and subthemes, are synthesized in Some studies showed that problems for supporting families were an important factor in AAC abandonment ,31,34,41Most family members shared that it was challenging to find the ways to get the support they needed related to AAC:“I think that if we were really shown the full capabilities of the system by the speechie [SLP] then it would just be ingrained in what we’re doing every day.” (p. 63)“We need to educate the teachers more… Because Anthony is not alone, and there are still [students] in this district who are completely nonverbal and don’t have a device.”…Until we got trained [on the SGD], it was like a foreign language. People say, “Oh you just have this machine.” But it’s really difficult unless you receive training … I don’t know, I just kind of wish we had more support, like maybe a person that can come in and make parents feel comfortable.” (p. 270)Consequently, parents expressed the need of individualized support, coaching, resources, and encouragement to use their child’s AAC system. However, this degree of support is difficult to achieve in many countries given logistical, resource, and policy barriers to service provision .Parents indicated various settings in which AAC accessibility was difficult, for example when camping, when living in rural areas, in public places and noisy situations, or in the car:“I may not talk to her as much. You know what I mean? Cause with her brother I can talk to him in the car. But with (Child) because she can’t answer me in the car… I don’t ask her questions.” (p. 242)“Nat, a parent who had previously lived in a rural area, remembered travelling long distances to see the specialist clinical team ‘every six months I think’.” (p. 78)Moreover, they mentioned some regulations that limited the use of AAC devices, as when insurance is not valid in another country.Parents expressed their perceptions of service providers: SLPs, therapists, and other professionals ,37,38,39“The therapist’s expertise is insufficient”, “I think there’s a need for AAC education targeting special education teachers.” (p. 325)Similarly, families stated that the responsibility of teaching the child and establishing the device should initially fall to the SLP or therapist, with parents gradually implementing home teaching.At the same time, families seemed to feel themselves devalued when professionals perceived themselves as the only ‘expert’ in AAC intervention:“They [the education department] treat you all like idiots, instead of collaborating, instead of sharing expertise they are just toxic and they couldn’t care less.” (p. 52)Families also expressed their disappointment at the deficiency in cooperation among the institutions responsible for their children’s education and therapy or parental training:“We need more inter-institutional communication or arrangements.” (p. 325)Families were also concerned about overlapping between services within a team. Parents noted a lack of consistency in services for families with a new AAC system and called for improved communication and co-ordination of services within and across settings, organizations, professionals, and parents:“They’ve not received any supervision from their special educator. So it’s ignorance, and they should need more material too. And who’s responsible? But everyone is—so no one takes responsibility. It’s sad—though it was probably meant to be the other way around.” (p. 376)The overlap and miscommunication between therapists or services shown in some studies ,31,39 co“Selena was diagnosed with cerebral palsy at 3 months, Charlie was swamped by the recommendations for home practice coming from Selena’s occupational therapist, physiotherapist, SLP, and others—at times adding to more than 27 hours of homework per day: ‘…and that didn’t take into account that she needed to be fed, she needed to sleep, she needed to have a bath, and she just needed to be a kid!’. As Charlie suggested: ‘I think if they started doing more of a multidisciplinary model… then everyone would be aware of what the other therapists were putting on the family…” (p. 79)Parents conveyed their perceptions about the usability and acceptance of the use of AAC by their children. Overall, the results were mixed ,33,38,41“My daughter uses the iPad. She’s incredibly free to be like everyone else when she uses it, compared to many other things. Here she’s more on the same level as her brothers. Here, there are suddenly things that she’s able to do herself. Then it strengthens her self-esteem.” (p. 375)“[PECS worked] pretty easily… he will just go up to them and he’ll tap them and he’ll show you what he wants.” (p. 413)child does not have to work hard to get point across’ and knows what she is reaching for.”  could give me any kind of support.” (p. 78)In some instances, parents did not perceive AAC systems as good value for money:“iPads are good but again there’s all that risk of the cost of them. So every time to fix a screen was $150 and after three times we just gave up and went well this is only gonna be in the house.” (p. 5)Most parents reported that they experienced difficulties finding time to support their child’s use of AAC and they felt that the use of AAC increases demands on their time. Families faced a multitude of challenges in daily family life, such as co-parenting, balancing the needs of siblings and family and employment commitments or lack of time to prepare materials. For example, they expressed their “difficulties sourcing pictures” for low-technology systems such as communication books and PECS. Therefore, parents felt frustrated because their responsibilities increased after the introduction of AAC ,38,39,40“I work full-time as a nurse, and my husband works full-time, and three kids and two older kids who are running in six directions. And unfortunately, we probably fall short of making time [to support AAC use].” (p. 270)“He wants to watch Sponge Bob all the time. Well he can’t, because there is 3 other kids. Or I am realistic so I know that I don’t work with her how I should I would like to, like sit with her and work, but then I started to think ok, you are working full time…” (p. 204)In sum, some parents described feeling overwhelmed because they had to deal with many responsibilities while seeking assistance and information of AAC services.Furthermore, some parents preferred to rely primarily on unaided communication  at home, especially in some daily life contexts as morning and bedtime care routines, when integrating AAC technologies  becomes a difficult challenge . Moreove“I think he just comes back home and thinks I am off I don’t have to use them anymore, I have free time, don’t bother me with pictures.” (p. 202)Parents were most likely to talk about inclusive education as a facilitator, emphasizing the benefits on language and other learning outcomes ,34,36,41“Actually, there is a big improvement from using a Tablet I know this through experience. Now for my baby, I brought the Tab to the centre on Friday to get the app inserted… Now my baby started working on a Tab from last week. Now she sits and works on it for 1 1 = 2 hours. She is now interested in it. That’s because she is used to the things in it… Honestly, my baby was ill over the last 3 days. But even while she was ill I put her to work. That’s because I have got this into me. I feel that the child is getting something out of this. … I sent the teacher the work that she did everyday through Viber and WhatsApp. So they looked at what we did and its shortcomings and told us how to change things. So, daily, from Sunday to today, I video recorded the work and sent it through WhatsApp … When we have so much technology, there is no point if we don’t take advantage of it, no?” (p. 188)Other parents perceived the education system as not accessible or inclusive, as the use of the AAC was not promoted in the school:“At school they kept taking [the AAC system] off him. And so then he just started balking at it and would only use it for school work because that’s the rules. And so even at home he would, he stopped using it so except for his homework.” (p. 63)“As long as I was quiet and didn’t understand my rights, I was a “good” parent. And it shouldn’t be like that … It’s all fine and dandy for a little while, but they stopped [providing inclusive services] and so I had to do a lot of advocacy, a lot of research to learn and things like that … There’s so many barriers, it’s so hard.” (p. 270)Additionally, some parents raised challenges associated with having a more restricted curricular focus and instructional tasks that weren’t viewed as being meaningful, limiting students with complex communications needs:“Evan, he hasn’t really been given a reading instruction… They don’t think children who are non-verbal can learn [to read]. So, they don’t really teach them.” (p. 268)Parents of younger and older children mentioned that their children spent most of their time with adults and were rarely left alone to interact with peers ,27,40. T“There were times—before the [name of communication device], she would want to be on the floor playing or whatever, but she will bypass playtime so she can communicate because that’s more important.” (p. 244)According to some parents, children with complex communication needs did not see peers after school or in shared activities, and few peers visited children at home because they did not want to communicate with them:“No-one comes. We’ve invited them but nobody comes. For her birthday this year it did work, two kids actually came. But we asked last year at the end of the school year if any of her classmates would mind just popping over in the summer time, spending an hour with her, or going to the movies with her, and no-one volunteered, so … [long pause] …” (p. 245)The methodological quality of all included studies was as follow: high (>8–10), moderate (6–8) or low (≤5) see . The 10 Q1. Was there a clear statement of the aims of the research?Q2. Is a qualitative methodology appropriate?Q3. Was the research design appropriate to address the aims of the research?Q4. Was the recruitment strategy appropriate to the aims of the research?Q5. Were the data collected in a way that addressed the research issue?Q6. Has the relationship between researcher and participants been adequately considered?Q7. Have ethical issues been taken into consideration?Q8. Was the data analysis sufficiently rigorous?Q9. Is there a clear statement of findings?Q10. How valuable is the research?Overall, the methodological quality of all included studies was deemed either high (n = 17) or moderate (n = 2)  or ethical issues.Learning an augmentative and alternative communication system is a long process that requires a lot of effort, both for the children and for the significant people in their lives. Moreover, it is also often a difficult emotional journey in which families may feel lost and have many doubts about what is best for their children. This comprehensive review has revealed some significant issues raised by parents, which may provide guidance to professionals and other stakeholders to help them cope with this process. Parents should feel accompanied and empowered in the endeavor of equipping their child with a communication system. Although there is a great deal of information available in the form of manuals, websites, videos, and training, more individualized support is required in order to cover the multiple and continuous demands of children with severe communication disorders and their families. While recognizing the need of families’ empowerment, professionals must also be conscious of their busy schedules, and efforts should be made not to overburden them.Families seem to advocate for transdisciplinary models of intervention composed of well-prepared professionals. This training and expertise must be extended to the school context, where teachers play a crucial role in generalizing the AAC use. A key related issue is the awareness of classmates about the functioning of AAC and their essential role in communicating with their peers with disabilities. This approach aligns with peer-mediated interventions designed to promote social interaction, a vulnerability area of children with complex communication needs. Additionally, parents have identified several environments where AAC accessibility is more difficult and, consequently, different actions must be carried out to break these barriers.Finally, it is important to highlight that although AAC is a fundamental means of communication for many children with AAC, some parents prefer to rely primarily on natural modes of communication  as they sometimes seem to be faster, easier, and smoother than the use of an AAC system. Enhancing and validating that kind of natural communication is another way of optimizing the communicative potential of children with CCN and their families.Summarizing, the results indicate that there are commonalities in challenges to AAC use within the included studies. These challenges consider different issues such as funding and time requirements, access to AAC tech, lack of skills, knowledge and training of service providers, lack of support from the AAC user’s team, and the impact of AAC in family, school, and social daily life. Additionally, challenges identified in the studies include the physical restrictions of the AAC user and the lack of adoption of AAC use in environments outside of the home.This systematic review presents some limitations. Most notably, the review yielded only 19 studies, and most of them with a small number of participants and a relatively wide age range, limiting the ability to draw broader conclusions. Another limitation was the limited reporting of AAC typologies in the original studies. Knowing not just the type of AAC, but how it was introduced is important to understand how AAC impacts parents’ perceptions. Finally, the findings must also be considered with respect to methodological limitations of the few studies included.Further research is needed that addresses the interactions between children with complex communication needs and their communication partners, which would help to conceptualize the nature of barriers and facilitators of using AAC systems in diverse environments. Similarly, research should aim to explore the interactions between children using AAC and their siblings or peers and identify siblings’ perceptions of AAC.The present review investigates parents’ experiences and perceptions as regards their children’s use of AAC, and identifies barriers and key aspects related to the use AAC by children and adolescents with speech, language, and communication difficulties. To date, this is the largest and most comprehensive review of the qualitative literature of parents’ perceptions and experiences of AAC.Findings suggest a need for more services that support children with complex communication deficits in different environments, more inclusive school programs (promoting meaningful engagement with peers), more functional use of AAC systems in real-world situations, and service support over an extended time period.The current analysis has important implications for stakeholders  in understanding AAC systems and providing support to children with communication disorders and their families.


A large and growing body of literature has investigated the role of teachers’ agency in their career trajectories. However, far too little attention has been paid to English as a Foreign Language (EFL) teachers’, especially female EFL teachers’, professional agency for their career development in the Chinese higher education setting. To address this gap, this study explores female EFL teachers’ professional agency from a self-discrepancy theory perspective, namely, how the participating teachers have perceived discrepancies in their professional development and how they have enacted their professional agency to realize sustainable development. Based on a metaphor investigation of 167 teachers and interviews with nine of them, the current study found that (1) there are certain discrepancies between female EFL teachers’ self-guides and actual selves concerning their professional identity construction; (2) female EFL teachers’ professional agency is manifested in the continuum of iteration, practical evaluation, and projectivity processes, as well as in the entity of personal and environmental factors; and 3) female EFL teachers’ professional agency and gender identity are closely intertwined with each other. This study can offer implications for teacher agency research and female teachers’ sustainable development at large. The sociocultural perspective in educational research  has geneThe chordal triad of human agency proposed by iteration, practical evaluation, and projectivity, referring, respectively, to the selective reactivation by agents of past patterns of thought and action, agents’ capacity to make practical and normative judgments among alternative possible trajectories of action, in response to the emerging and changing situations, as well as the imaginative generation by agents of possible future trajectories of action, when they creatively reconfigure their thoughts and actions according to their hopes, desires, and sometimes, even fears for the future.To be an agent is to intentionally make things happen by one’s actions, and agency embodies the endowments, beliefs, self-regulatory capabilities, and distributed structures through which personal influence is exercised . The choTeacher agency is considered as teachers’ essential professional capability, which means that teachers as learners and agents can intentionally plan, act or not to act, and reflect upon their behavior and, hence, develop teachers’ competencies and exert influence upon their career trajectories , 2021. Ostatus quo of teacher agency for professional development and its influencing factors. In recent climate, researchers in China have conducted a large number of empirical studies to explore the efficacy aspects of teacher agency. Female teachers constitute a large cohort of the whole teaching population in the higher education context in China. According to the official statistics from the As for female EFL teachers, although their population dominates the whole teaching cohort, but there are often bottlenecks restricting their professional development . AccordiAgency is found to be closely related to female identity, and female teachers’ professional agency is intertwined with their gender identity . AccordiAccording to Moreover, Higgins argued that it is not enough to distinguish among different domains of self. It is also necessary to discriminate among self-state representations by considering whose perspective on the self is involved and, hence, the standpoints on the self. Combining each of the domains of the self with each of the standpoints on self-yields different types of self-representations.Self-discrepancy is the gap between two of these self-representations. The self-discrepancy theory postulates that these different representations of the self can be contradictory to each other, which inevitably results in certain degrees of emotional discomfort. The theory claims that people are motivated to reach a condition where our self-concept matches our personally relevant self-guides , p.321.Furthermore, The notion of self-discrepancy is closely related to the construct of teacher agency. As mentioned earlier, “selecting,” “acting,” and “compensating” are the major dimensions and features found in teacher agency. As (1) Which discrepancies have the participating teachers perceived in their career development?(2) How have they enacted their professional agency to bridge the gap of different self-guides?Qualitative research is interpretative and the inquirer is typically involved in a sustained and intensive experience with participants , which sTo be concrete, a phenomenological qualitative research design was adopted in the current study, in which an initial metaphor investigation with 167 female EFL teachers in China informed in-depth interviews with nine of them during the data collection, not only generating an overall picture of the group but also zooming in on individual cases.Through a comprehensive consideration of purposive sampling, convenience sampling, and snowball sampling , the stuAfter careful reading of the metaphor investigation, we solicited representative answers which have the potential to generate more findings in the subsequent interviews and asked for the willingness and availability of the participants for the follow-up data collection. Subsequently, nine teachers were recruited in the second-round interview.The basic information of the participants are presented, respectively, in What kind of metaphor would you use to express your self-guide? and what kind of metaphor would you use to express your actual self?1). Through a process of a pilot study, revising instructions, and formal investigation, 167 valid metaphor questionnaires were collected and analyzed.Metaphor is a powerful artifact and a tool for opening up possible conceptual territories for exploration of their connections and dynamics in constructing knowledge . AccordiWe thematically analyzed the metaphor questionnaire and selected nine of the 167 teachers to attend the second-round data collection—semi-structured interviews . Due to First, we conducted a frequency count of the metaphor questionnaires collected to get a general scenario of female EFL teachers’ identity commitment; second, we conducted a qualitative content analysis of the participants’ description of how and why they had selected each metaphor; third, we transcribed the interview recordings verbatim, which generates 276,213 words for further analysis; finally, we conducted thematic analysis by coding, categorizing, synthesizing, and theorizing  the mateWith an aim to ensure the trustworthiness of the research , the folThe following section presents the research findings based on the two research questions proposed.To address the first research question, the following two sections present the findings both globally and concretely on the basis of metaphor investigation and interview.2 ‘‘sunflower,’’ and ‘‘broken butterfly cocoon’’ suggest that the qualities valued by the female teachers are resilience, optimism, and self-growth; metaphors of ‘‘rainbow,’’ ‘‘kaleidoscope,’’ ‘‘candles,’’ and ‘‘breeze’’ expressed teachers’ expectation of varied roles, their dedication, and longing for a refined temperament. When they refer to their actual selves, metaphors of ‘‘explorer’’ and ‘‘running man’’ suggested teachers’ continuing attempts for self-improvement; metaphors of ‘‘octopus,’’ ‘‘dandelion,’’ ‘‘dancing leaves in the wind,’’ and ‘‘migrating birds’’ demonstrate that female teachers endeavor to seek direction against external hardships; and metaphors of ‘‘winding mountain road,’’ ‘‘seesaw,’’ ‘‘panacea,’’ and ‘‘Alipay’’3 reveal the participants’ determination to realize diversity in the developmental paths.Through an analysis of the metaphor investigation, it is found that the participating teachers tend to use human beings, plants, animals, natural phenomenon, and sports events to express their identity commitment . When reInterview with the teachers suggests that self-discrepancies perceived by female EFL teachers are manifested in the harmonious coexistence in rhetoric and the role conflicts of different identity commitments in reality. As Orchid from a Project 211 university said:Extract 1.Female EFL teachers should not only do teaching and research well, but also try to become life-long learners. What’s more, we have the obligation to look after the family. These tasks are hard enough to tackle with, which requires us to become “iron women.”It can be found from the quote that female EFL teachers’ perceived role conflicts and self-discrepancies are manifested in multiple professional tasks, namely, teaching, research, and teacher learning commitments.Research findings show that the English curriculum reform is one of the biggest challenge teachers face in their teaching. Many teachers expressed their determination to “keep pace with the changing requirement of teaching,” while many realized “hardships and challenges” in the curricular reforms.Carnation, with 18 years of teaching experience in a renowned foreign studies university, showed her earnest love for teaching as a middle-aged veteran teacher:Extract 2.I think no matter what courses to teach, it is a process of familiarization and enhancement. I am not that type of teacher who always stay in the comfort zone, say, if the textbook remains the same, the teacher could use the same teaching plan for several rounds.Mimosa earned her doctoral degree from a world-renowned university abroad. Although she’s eager to implement reforms in her classroom, she faced many challenges.Extract 3.I really wanted to flip the classroom by assigning lots of homework  before and after the class while encouraging my students to hold discussions and interact with each other in class. When I saw the score they have given to me in the teaching evaluation session, I was so disappointed. Perhaps I was too strict with them.Teachers also referred to their contradictions and embarrassment in their research engagement. Tulip from a comprehensive university expressed her helplessness regarding the requirements made by her university for the promotion of professional titles:Extract 4.Although the university distinguishes teachers as “research-oriented” and “teaching-oriented” in the promotion processes, generally speaking, the requirements about research are strict. How many journal articles have you published? Where have you published these articles? These are all quantified. It is pleased to see teaching has been given more weight in the promotion processes recently, but you can never quantify teaching like research.Violet mentioned that “the combination of teaching and research” advocated by the university is almost a castle in the air:Extract 5.My research direction is theoretical linguistics, which, honestly speaking, has nothing to do with my teaching. If you want to stay up-dated in research, you should read, read, and read, therefore you can figure out what the research hot spots are. I don’t believe in the nexus between research and teaching.Female EFL teachers consider themselves as “lifelong learners,” yet the actual role conflicts made them less concentrated on workplace learning and self-improvement. Osmanthus had been a college English teacher at a medical university before she pursued her doctoral university in another university.Extract 6.As a full-time teacher with more than ten periods of classes to teach each week, I need to prepare for the lesson, arrange classroom activities, coach students, and attend many meetings. It is almost impossible for me to study. Therefore, I decided to quit my job and become a full-time doctoral student. Only in this way can I concentrate on my own research.Rose mentioned that both the summer vacation and winter vacation are good opportunities to learn because she can stay at home or in the library to get herself “charged.”Extract 7.Before the summer vacation and winter vacation start, I usually borrow some books from the library to read, which are closely related to my research. Another thing which is also very important is “going out”. During my 20 years of teaching career, I have applied several times of visiting study abroad. Being they several weeks or one year in length, they are really beneficial to me.It is found that teachers enact their professional agency actively to bridge the gap between their self-guides and actual selves, which is manifested in the continuum of history, present, and future and is situated in the dynamic interaction between the self and environment.The enactment of teacher agency is closely related to teachers’ learning experience, professional history, their belief system, and their behavior style. Lily, a lecturer from a finance-oriented provincial university, contributed her motivation for continuing professional development to her self-control developed when she was a student.Extract 8.Every time I go back home, I am surround by my daughter. After she goes to bed, it is usually mid-night. I am afraid that I should fall sleep with my her, so I set an alarm clock to wake me up and then go to the study room for lesson preparing or literature reading. This habit originates from my high school days, when both of my parents were too busy to supervise my study. So I am kind of an independent and a clear-visioned person.The female EFL teachers in this study also emphasized the significance of selecting, acting, and reflecting. They claimed that one should not only have the self-efficacy to believe that she can do it but also have the ability to transfer her plan into reality. Sunflower recounted her experience in teaching the academic English writing course.Extract 9.Academic writing, to our knowledge, is a bit dull and daunting course if I taught students about the thesis structure, academic words and phrases. I intentionally borrowed an idea from a Korean reality TV show called The Running Man to let my students “learning by doing”. They went to the library in groups to search relevant literature, send pictures to the online discussion group, and went back to the classroom for group discussion. In this way, their critical thinking, team-work, and problem solving skills are crafted.Both short-term and long-term planning determine the direction where agency will development. Osmanthus believed that in order to balance family and career, it is crucial to have plans and act them out.Extract 10.Family and career are two important lines which needs meticulous planning. In different stages of life, there are different emphases. When the two lines intersects at some point, self-management counts. When you accompany the kid and coach his or her homework, you’d better forget about your research and teaching identities and when you immerse yourself in your work, you should not consider too much about your family. Anyhow, you can never do your work well without a loving and supporting family.Violet referred to a “to-do list” when she talked about self-management and self-supervision.Extract 11.When I was a student, I usually create lots of “to-do-lists”. It gives me sense of fulfillment when I finished the items on the lists. Now summer vacation is coming, I made a to-do-list for myself again.The dynamic interaction between the self and environment has penetrated the process of teacher agency enactment. For one thing, how teachers exercise their agency is deeply influenced by their personal attitude and ability.Carnation assumed that if the teacher wants to “offer students a drop of water,” he or she should “have at least a bowl of water.” Additionally, “this bowl of water” needs constant refreshing.Extract 12.Our millennial students are really talented and smart with good English proficiency. Therefore, I do believe in the value of “information gap” between one student and the other, and between the students and the teacher. Keeping learning as a habitual thing is really important.Sunflower believed that teaching is the ongoing processes of attempting, learning, and reflecting.Extract 13.This semester, I began to teach students English newspaper reading course, which is a completely new realm for me. I kept “teaching by learning” and after a whole round of teaching has completed, I realized there are many limitations. It doesn’t matter, I will take my time to grow.For another, it is found in this study that environmental factors also shape how teachers enact their agency. Mimosa referred to herself as a motivated and ambitious teacher, yet her husband “not recognizing her work” frustrated her from time to time.Extract 14.Once I talked to him (my husband) that my ultimate goal is to be promoted as a full professor. He replied me without a second thought: “How come you dream to be a full professor!” As a researcher with science background, he can hardly understand the value of humanistic research. He believes that most of my work done are less meaningful. Therefore, he hopes me not do any “extra work” except for ten periods of classes each week.Rose contributed her growth to her female role models, with her mother and grandmother exerting positive influences.Extract 15.Both my grandmother and mother often said: “I like to see things grow”. This simple but powerful sentence has left me with great and lifelong impact.Lily realized that institutional culture and institutional support are very important for female EFL teachers’ sustainable development.Extract 16.My university is one with industrial features, which leaves very limited space for female College English teachers. We do not have much discourse power and the path for promotion is really narrow. I often have the feeling of going into a dead end.Orchid emphasized a positive and healthy ecology for female teachers’ career development.Extract 17.Our teaching department established a learning community recently, which, I think is a good thing for those with similar research interests to share and discuss. We meet each other every Wednesday afternoon.Most of the teachers also showed their expectation for the understanding from the whole society.Extract 18.We really hope there will be more voices from the society to support us. Family management needs the joint efforts of both the husband and the wife. Those female teachers who have pursuits in their career should not be labeled as irresponsible and selfish.The aforementioned sections have addressed the two research questions, respectively, with the metaphor investigation showcasing female EFL teachers’ overall expectations, actual situation, and existing gaps, and the interview demonstrating female EFL teachers’ perceived discrepancies in teaching, research, and teacher learning and complicating how these teachers enact their agency to deal with the discrepancies and role conflicts through the constant endeavors of past, present, and future, as well as the meticulous negotiation with personal, interpersonal, and sociocultural factors.With an aim to explore female EFL teachers’ perceived discrepancies in teaching, research, and teacher learning and the ongoing dynamics of their agency enactment, this study claims that although there are discrepancies between female EFL teachers’ self-guides and actual selves, teacher agency is a significant entity by which they can bridge the gap between rhetoric and reality and to seek sustainable career trajectories.First, female teachers do have positive self-guides concerning their identity commitment and professional development, while at the same time, they realize that actual selves are restricted by certain internal and external forces. Exploring female teachers’ ideal self, ought self, and actual self through a way of metaphors reveals teachers’ identity construction and negotiation. Metaphors can not only dig deep into teachers’ inner self but it can also reveal the influences of the sociocultural contexts upon teachers’ personal development. This has shown metaphor’s feature of cognition, experience, and dependence on society and culture as a research approach . EmpiricSecond, the self-discrepancies facing female EFL teachers are manifested in the idealized coexistence of different roles and the actual conflicts of these roles in reality. Teachers perceive discrepancies in their professional development from different aspects, such as teaching, research, and teacher learning activities . The disstatus quo, bridge the gap, mediate the motivation, and carry out meaning-making activities. This, to a great extent, has echoed with Third, when teachers perceive discrepancies, sense of negative emotions emerge, such as lack of motivation and lack of desire for professional development, accompanied with self-doubts, occupational burnout, sense of depression, and sense of frustration, etc. However, it is also the perceived discrepancies and negative emotions which can push teachers change the time is the first important dimension of agency enactment.For one thing, teachers manifested features and qualities of “selecting,” “acting,” “planning,” and “reflecting” when exercising their agency , and teacontext is the second important dimension of agency enactment.For the other, teacher agency is the integration and interaction of personal, institutional, and sociocultural factors . As propIt is also claimed in this study that female EFL teachers’ professional agency is intertwined with their female identity commitment, which reveals that professional agency is an open entity influenced by gender agency . It is fBased on the aforementioned illustrations, this study claims that teachers’ self-guides determine the projective aspect in the “chordal triad of agency”; their actual self-echoes with the practical evaluative aspect of agency; teachers’ ideal self, ought self, and actual self are influenced by the learning and teaching history in the iterative aspect of agency. For one thing, self-discrepancies are the driving force for teachers’ career development ; self-diFemale EFL teachers in the higher education setting face inevitable discrepancies between self-guides and actual selves. Through a series of meaning-making efforts in acting and selecting, they enact their professional agency and attempt to narrow the existing gaps and, hence, seek sustainable career development. Based on the current study, it is suggested that (1) female EFL teachers are to establish grand professional ideals; hold self-efficacy in handling complicated relationship between family and career, working and learning, and teaching and research; cultivate positive professional emotions; enhance teacher knowledge  and research literacy to promote teaching competencies and teacher leadership; craft the ability in time management, self-control, rational judgment, positive planning, and reflective learning; and seek external help and positive values from role models when enacting their agency; (2) faculties are to encourage teachers to build learning communities, provide a transparent and fair pathway for promotion and continuing study, and offer positive emotional wellness counseling while necessary; and (3) the family members of female EFL teachers and the whole society at large are to eliminate prejudices, give more understanding concerning female teachers’ career development, and show respect for their personal choices and work engagement.This study adds to our knowledge of female EFL teachers’ agency enactment and offers referential implications regarding female EFL teachers’ professional development; however, it inevitably has its limitations; for example, this study only focuses on the participants’ articulated beliefs and practices through metaphor investigation and interview, yet how these teachers actually do remains vague. Future studies can incorporate research approaches, such as observation and netnography, to reach a more comprehensive understanding of the issue.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.XR: conceptualization, methodology, funding acquisition, formal analysis, writing – original draft, review and editing, and investigation. AT: conceptualization and writing – review and editing. Both authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Delayed discharge from inpatient mental health units is the continued hospitalisation of consumers after being assessed as ready to be discharged. This is common in adult inpatient mental health services and is usually due to a lack of appropriate housing for discharge. Research indicates a range of possible negative impacts, but no studies have explored consumers' perspectives on this issue. This study explores consumers' perspectives of the experience of housing related delayed discharge (HRDD).Using a grounded theory approach, in‐depth interviews were conducted with 10 consumers. All consumers were experiencing HRDD from inpatient mental health units in one Sydney local health district. The data were analysed using constant comparative analysis.A lack of choice and control was the central theme that characterised participants' experiences. The combined experience of being delayed in hospital and being homeless led to a lack of choice and control over the basics in life, how consumers spent their time and with whom, and their futures. This lack of autonomy was shaped by the features of the hospital and participants' personal circumstance. The hospital features included rules and routines, physical and social environments, resources, and support from staff. Personal circumstances included individual situations, social networks, and support from community organisations. Participants described a variety of impacts, including reduced mental and physical well‐being, and anticipated difficulty transitioning back into the community.This study is the first of its kind and provides consumer perspectives on the impacts of HRDD on their well‐being and recovery. The inability to participate in meaningful and necessary occupations is an occupational injustice and implies the need for occupational therapists to advocate for both the prevention of HRDD through government investment in affordable and readily available housing and the mitigation of its effects through modified hospital environments and practices. HRDD is characterised by a lack of choice and control over one's daily life.HRDD is an infringement of consumers' occupational rights.Occupational therapists should advocate for all consumers who experience HRDD.1Delayed discharge from inpatient mental health units is the continued hospitalisation of people living with mental health challenges after being assessed as medically fit for discharge  , There is a growing literature exploring delayed discharge from mental health inpatient units. However, it is mainly focused on identifying rates and predictors of delayed discharge and discussing potential impacts on the hospital systems  on the outskirts of Sydney in New South Wales (NSW), Australia. The LHD has a large tertiary referral hospital with four inpatient mental health units and several smaller, geographically dispersed hospitals, one of which includes a 15‐bed general acute unit. Wards are locked, so consumers' freedom of movement is severely restricted regardless of whether they have been admitted voluntarily or involuntarily. With approval from the treating team, consumers can usually access leave to complete tasks such as banking, shopping, or spending time with family.Much of the occupational therapists' time is occupied with assessments and discharge planning including preparing detailed rehabilitation referrals, National Disability Insurance Scheme (NDIS), and other applications for housing and support services and advocating for consumers as they navigate complex discharge arrangements. Other tasks include attending multiple multidisciplinary ward rounds, case conferences, working with consumers' families, and supporting consumers to access other essential supports. Along with nursing and diversional therapy staff, occupational therapists also run programed activities. However, as they work office hours only, implementation of evening and weekend activities depends on the availability of nursing staff to supervise. While there is also some opportunity for individualised therapeutic interventions, the primary focus for occupational therapists is discharge planning to facilitate timely discharge and support patient flow.2.3Participants were recruited from two of the inpatient units between February and September 2020. They were a purposive sample of inpatients who met the following criteria: (a) working age (16–64 years old) and (b) assessed by their treating team as ready for discharge but awaiting housing. Consumers awaiting aged‐care placement were excluded as their experiences of delayed discharge were likely to be different  basics in life, (b) how I spend my time, (c) who I spend time with, and (d) my future.3.3.1Participants spoke of being unable to exercise choice and control over basic occupations like eating, sleeping, taking medication, and performing self‐care. This affected their mental and physical health and well‐being. Participants were ‘forced to do things at certain times …, have a shower at this time, eat at this time’ (Gabriel). For example, James noted, ‘there's set times that we get the food … does not help you when you are hungry’, while Mary reported being unable to participate in daily self‐care activities when desired: ‘if I want a razor, I've got to go see them … I cannot just do whatever I want, like what I need to do’.Crowded and noisy hospital wards, coupled with regular monitoring and surveillance by hospital staff, meant that participants had little control over when they slept. Frequent ‘room searches’ where ‘nurses come in with torches every hour or so’ (Michael) were intrusive and affected participants sleep: ‘sleeping is the worst. Everyone knows you do not get much sleep in the hospital. But in a mental health ward, it's worse’ (John).Hospital rules left little room for self‐management of medication. For example, to limit the side effects, Mary noted, ‘I never used to really take the medication in the morning, I'd take just a small dose to keep my levels’. However, while in hospital, participants had to take the medication they were given when it was given, even if they did not understand its purpose.3.3.2All 10 participants noted that the biggest effect of being in hospital was the inability to use their time for meaningful occupations. Although participants noted that activities, like exercise, art, and crafts, were offered in hospital, they were not always available. Michael reported, ‘there's a gym, but the nurses have to watch you … so if the nurses are not available, you cannot use the weights’. Participants often could not watch the television program of their choice because ‘other people in here take control of the television’ (Eve). Even reading the newspaper depended on ‘if there's a free nurse available to go to the hospital kiosk to purchase those newspapers’ (Gabriel).Furthermore, the resources and activities offered in hospital did not necessarily suit participants' needs and interest. Gabriel noted, ‘there's things like painting and drawing …, but we are not kids, there's no kids in here, we are all adults’. Hospital resources were sometimes old and unreliable, with Eve reporting ‘the computer stuffs [up] all the time’. Engaging in other meaningful occupations, such as surfing, shopping, and caring for family, was usually impossible.3.3.3Being in locked wards with restricted leave meant that participants were unable to choose who they spent time with. Participants often noted being ‘forced to live with’ unfamiliar people: ‘there's no escape, you are stuck all together, there's no sort of time out’ (Gabriel). The constant admission and discharge of other consumers also meant that the hospital ‘environment is changing every single day’ and that ‘it'll never get to a good state’ (Gabriel). While ‘pleasant’ interactions with staff and consumers were occasionally reported, several participants reported witnessing frequent screaming, arguing, and threatening behaviour: ‘it's always loud, there's always someone going off, I do not feel like, at home’ (Michael).HRDD also meant that participants were unable to choose when and where they could see their loved ones. For several, seeing their friends and spending time with family were activities they most looked forward to once discharged.3.3.4Participants lacked choice and control over important aspects of their futures, such as when they would be discharged and where they would live. Restrictions around hospital leave and internet access limited participants' ability to do the occupations needed to arrange their accommodation: ‘we only have an hour here or there, … we cannot make appointments [with agents]’ (Gabriel). This difficulty in organising accommodation from hospital and the limited available housing options meant that participants had to rely on hospital staff, housing services, or family to arrange their accommodation, further limiting their ability to choose where to live.As such, several participants anticipated that they would have to compromise on their discharge location and be discharged to non‐preferred accommodation. James, for example, agreed to accept a place in a group home, despite his reluctance, while four participants noted they would accept temporary accommodation, hoping this would give them a chance to look for suitable permanent housing.Four participants also reported that HRDD restricted their ability to participate in other occupations that they needed or wanted to do to help them move their lives forward, such as finding employment, enrolling in Technical and Further Education, and resolving legal issues.3.4Participants noted three key impacts that resulted from a lack of choice and control: reduced mental well‐being; decreased physical health; and a more difficult anticipated transition back into the community.mental well‐being, most often due to being unable to engage in desired occupations. Many reported frustration and boredom: ‘I'm more agitative … agitated and irritable while I'm in here, yeah, because I cannot do the things I want’ (Mary). The central importance of choice and control was highlighted by two participants who expressed frustration over their lack of autonomy even though they reported that their daily routines while hospitalised were not appreciably different when they were outside of hospital. For example, John reported that he would usually ‘just walk back and forth drinking coffee [and] eating food’ whether in hospital or at home. Most participants described feeling lonely and ‘cut‐off’ (Eve) from their loved ones and many noted that living in crowded and ‘claustrophobic’ hospital wards, with unfamiliar people, was often ‘stressful’, anxiety provoking, and destabilising for their mental health.All 10 participants reported having reduced physical health challenges getting adequate nutrition, exercise, or sleep, which sometimes made them feel unwell: ‘I'm doing it a bit hard without many greens’ (Simon), and ‘I have not had much of a day for a while, because I've been … sleepy’ (Eve).Several participants noted that being in hospital for so long affected their transition back into the community. Mary noted, ‘when I get out, I know I'm going to have a bit more anxiety about getting around doing things’, while Gabriel explained, ‘it'll be a slower transition. It'll be slow and frustrating’. Other participants were concerned that being unable to practise or demonstrate their independent living skills in hospital might affect their transition. For example, Simon thought that his chances of getting accommodation would be affected by not having had the opportunity to show that he was ‘alright in cleaning and cooking’. However, two participants also described benefits of staying in hospital, despite the negative impacts. For example, Mary found it preferable to the alternative of being discharged into homelessness: ‘I cannot find accommodation just yet, that's why it's a good thing that I am allowed to stay here until next month’.Participants also anticipated a more difficult 3.5It is apparent in the above analysis and examples that participants' experiences of lack of choice and control were shaped by two situational factors: (a) hospital features and (b) my circumstances. These situational factors also influenced the extent to which the lack of choice and control impacted participants, as depicted by the dotted arrows in Figure 3.5.1Hospital features which shaped participants' choices and experiences were the rules and routines, physical and social environments, resources, and support from staff.Hospital rules and routines were particularly critical in shaping participants' choices. Most prominently, being in locked wards, participants could only leave the hospital for a limited time. Often participants were only allowed to leave the unit when escorted by approved family members or service providers, either due to being held under the Mental Health Act or perceived absconding risk. The duration and conditions of leave varied between individual patients but were always determined by their treating team. They were also subject to fixed ward schedules and routine monitoring and surveillance by staff, which affected participants' sleep and well‐being. Six of the 10 interviews were also conducted during COVID‐19 hospital restrictions. Three of those participants noted that these restrictions exacerbated the restrictive features of the hospital, as for a period they were not allowed leave or visitors.The physical environment influenced participants' choices about how to spend their time and with whom. This led to reduced opportunities for spending time alone, relaxing, and sleeping.The social environment affected what people could do and the extent to which people were affected by not being able to choose their company. While positive social interactions provided distraction and made hospitalisation more bearable, participants' experiences were negatively affected when other consumers were noisy, argumentative, or threatening.Resources like the gymnasium, television, outdoor courtyard. and computer increased options for occupation. But these resources were limited, and some were not ideal or adequate for everyone. The availability of hospital staff to provide or supervise activities was another valuable hospital resource which either enabled or limited participants' options for activities.Support from staff to access housing and manage housing related issues was critical to participants' choices and experiences. Most reported receiving support from staff to find accommodation, explain the housing process, and complete paperwork. However, this was not consistent, and some experienced a lack of such support.3.5.2Participants' circumstances such as individual situations, social networks, and support from community organisations affected the extent of their choice and control and influenced how the lack of autonomy affected them.Individual situations included personal and contextual characteristics. All participants needed housing, but some were in a better position to acquire it. For example, some had the financial resources and knowledge of the housing market or were entitled to social housing. Participants' dispositions and relationships with other consumers and staff also impacted their experience of HRDD. For instance, Gabriel felt that his calm and tolerant disposition helped to reduce the impacts of other consumers' negative behaviours.Social networks, such as support from family, influenced participants' experience of HRDD. Participants with family members who visited them, brought them food, took them out, and helped them to arrange discharge accommodation experienced more choice. However, the amount of family support varied between participants.Support from community organisations was particularly important to participants who did not have family support. Service providers from non‐government organisations or community mental health would sometimes visit participants, take them for escorted leave, or help arrange discharge accommodation. They also promised support beyond hospitalisation, with participants' transition into the community.4This study is, to the best of our knowledge, the first to examine consumers' experiences of HRDD. A lack of choice and control was the central theme. This encompassed a lack of control over daily occupations and routines, including necessary occupations for finding accommodation and preparing to transition to the community. Some features of the hospital environment and personal circumstances exacerbated these experiences, while other environmental and personal factors mitigated them. Overall, the impacts on consumers were negative. These included decreased mental wellbeing and reduced physical health and anticipation of greater difficulties transitioning into the community. Interestingly, participants did not distinguish between the overall experience of the admission and the experience of the period deemed as HRDD. They often did not appear to be aware that there was a point in their admission where they were assessed by clinicians as well enough to be discharged as soon as suitable housing was sourced. However, participants did specifically identify the restrictions of the inpatient mental health environment as preventing them from completing occupations that would enable them to secure housing and facilitate their discharge. Therefore, HRDD can be considered as an extension of the period consumers experience the negative impacts of the restrictive inpatient environment and as a barrier to resolving housing concerns.Previous research has highlighted the necessity of meaningful occupations for recovery and wellbeing , mesolevel  and macrolevel (population) , which emphasised the interaction between hospital restrictions and housing choices, most aspects of the findings may be equally applicable to people whose discharge was delayed for other, non‐housing related reasons. However, further research with this group is needed to clarify this. This paper represents only the subjective perspectives of consumers. Perspectives of other stakeholders, such as occupational therapists, other ward staff, or families, may well be different. Lastly, it is acknowledged that people living with serious mental health concerns may well experience limitations in their abilities to participate in meaningful occupations, even when living in the community. For example, Harvey et al.  found th5HRDD is characterised by a lack of choice and control over one's daily life. If the Australian government is committed to upholding the rights of persons with disabilities, as per their obligations to the CRPD, and to providing recovery‐oriented mental health services, it is imperative that HRDD is prevented through investment in affordable and readily available housing and support options and that its effects are minimised through modified hospital environments and practices. Given the implications of HRDD for occupational justice, the occupational therapy profession should be at the forefront of efforts to bring about these changes.The authors declare no conflict of interest.All authors contributed to the conceptualisation and planning of the project, inspired by Author 3's observations of problems associated with HRDD in the LHD. Data were collected by Authors 1 and 2, an occupational therapy honours student and academic, respectively. All authors contributed to data analysis and the final paper.


COVID-19 has continued to effect higher education globally in significant ways. During 2020, many institutions shifted learning online overnight as the sector closed its doors and opened new sites for remote teaching. This article reports on an international study [Phillips et al.,  This research forms part of a larger cross-sectoral study investigating teaching and learning during COVID-19 . This may, for example, include experiencing emotional contagion, which is the transference of emotional states. That is, if students view their teachers as positive and complimentary, they may mimic their teacher’s behaviours, using nonverbal reactions. This type of feedback serves to predict how a teacher perceives their teaching within the classroom. These positive interactions contribute to building a teacher’s self-confidence and self-efficacy and confirm that their teaching style is effective and appreciated. Significantly for this pandemic study, when HE teachers experience positive emotions, they feel “energised and motivated to try out new technologies and ways of engaging with students”  research with 1148 university educators in the UK, respondents described feeling ill-prepared, lacking confidence, and lacking sufficient institutional support. In reference to the abrupt nature of moving online (with many teachers having only two days’ notice) one respondent lamented “I would like to engage in more training to become a more tech-savvy lecturer, but with no time to prepare, play, explore the technologies available, at the moment I am merely stressed out of my wits, as are my students” (p. 11). Respondents also expressed their reluctance or unwillingness to learn new technologies and skills; seemingly resigned to a negative outcome with one person stating “I have no real training in online course design. I have no interest in teaching like this anyway, and there is no possible way I am going to invest in completely re-doing this course on the fly” (p. 12).Naylor and Nyanjom  accurateTeaching is inherently a social practice, and care is integral to successful teaching. Rose’s  seminal The vast majority of respondents in Watermeyer and colleagues (2020) research viewed the move to online teaching and learning as a negative experience, feeling that their pedagogical praxis had been reduced to “rudimentary technical functions” (p. 9). One respondent missed the personal connections in the classroom and described feeling like a ‘faceless’ purveyor of education, expecting their role was now to “transmit academic information rather than teach and model an academic ethos” (p. 10). What respondents did not predict was how much their pastoral role would increase, with more time spent counselling students and worrying about how to support those with mental health concerns. In addition, an ‘exponential’ increase in workload and demands on their time was highlighted leading respondents to feel exhausted and socially isolated.The recent Pivot Report . Although agency and autonomy are integral to the teaching profession, suggests Farquhar , the teaUsing a snowballing recruitment technique via social media, the participants in the study were 635 teachers working in early childhood education, primary schools, secondary schools, and university settings. This article reports on the 105 respondents in the HE/tertiary sector. There were 42 from the USA, 40 from Australia, with three each from Singapore and Canada, two from Japan and Fiji, and 13 other countries that had one respondent each. Each respondent was given a numeric code which was used in the analysis. The age range of the respondents was 40% (n = 42) aged between 45 and 54, 26% (n = 27) aged between 55 and 64, and 20% (n = 21) aged 65 and over. Only one person was aged 20–24, and three were 25–34. The next smallest age group was the 35–44 age group with 10% (n = 11) of respondents. In this HE subset 72% (n = 75) had either a PhD or EdD (Doctor of Education), whilst 22% (n = 23) had some sort of post graduate qualification and 6% (n = 6) had a degree. From this cohort 53% (n = 56) had over 21 years of teaching experience, whilst 21% (n = 22) had 16–20 years of teaching experience and 11% (N = 12) reported teaching for 11–15 years. This meant that 85% of our participants had over 10 years of teaching experience. Only 8% (n = 8) had 6–10 years’ experience and 6% (n = 6) had been teaching for 3–5 years and just one participant was in their first year of teaching. Interestingly, only 10% (n = 10) of the respondents had already been teaching online before remote emergency teaching began.This study was designed using survey-based methodology which allowed it to be based online using Qualtrics, an online survey tool to create the survey and host the survey. Using a snowballing technique, participants were able to pass the survey onto other teachers they knew who might be interested in completing. Social media was also used to allow for distribution of the survey as well as professional bodies in Australasia such as ASCILITE and HERDSA.Prior to the research being conducted, the authors obtained human ethics approval through their respective institutions and co-designed a qualitative survey consisting of 16 open-ended questions with Qualtrics software used to gather responses (see Appendix A). The initial questions were devised to source demographic data such as the teachers’ age, discipline areas, years of experience in teaching, and previous experience teaching online. The next questions centred on their perceptions of how their students’ learning had been affected with a focus on adjustments for diverse learning needs. Questions then addressed technological, pedagogical, and personal needs, as well as challenges and support systems. Finally, participants were encouraged to share a story of success and reflect on what they had learnt about themselves as educators and co-learners. When using participant quotes to support the themes, each participant was given a number preceded by ‘Pt’ .We need each other, and sharing our stories brings us closer together (Pt48). These stories were captivating. Some made us smile and others caused us to shed a tear. As fellow HE teachers, we could empathise deeply. Through this emic perspective, it became obvious that we needed to engage with the data comprehensively, across themes and not confined by the parameters of each question, to gain a sense of the whole and the nuances that lay within. We chose to follow several complete narratives, building representative case studies to analyse. With more than two thousand lines of data, this took considerable time, but we appreciated the detail and wanted to honour this.With data collection beginning in May 2020, this study was opportune for participants and researchers alike. The respondents were particularly giving of their time, sharing challenging personal experiences and in more detail than expected. Our initial encounters with the data in digital spaces  suggested that this may have been the first time the respondents took time to reflect on the ‘chaos’ that ensured when COVID-19 restrictions transformed their teaching instantaneously. Indeed, it appeared particularly cathartic for some. The importance of this opportunity was often noted: https://atlasti.com/) and the coded result exported to Excel to enable basic counts and listing of codes sorted by Respondent ID or by Code. Responses were assigned an ID number so that the coded results could also be sorted by Respondent ID or by Code. Coding followed a process of assigning a descriptive label or code to a comment or quotation; these text selections ranged from a phrase to several sentences. As higher education teachers, the researchers did not deny possible bias, but recognised and utilised the advantages of this emic perspective in the analysis.As an interdisciplinary research team, the data was interrogated by each researcher separately. The data was coded in Atlast.Ti , we had expectations of what we might encounter. Initial tales of frustration, exhaustion, and anxiety were prominent. This inceptive fear and confusion strongly aligned with Kim and Asbury’s  theme ofquick race to develop online materials (Pt40). They emphasised a sense of confusion and some panic from students (Pt40), and that they had difficulty answering questions about how the semester will proceed (Pt40). For educators that take pride in the quality of their materials and delivery, this sudden rush was reactive rather than proactive (Pt29). One respondent from the USA with over 21 years’ experience as a HE teacher explained this experience:All courses were moved online with two-day notice. Not only had I very little experience with distance learning, but also little interest. Fortunately, I had had seven weeks with my students [prior to closures] so that the relationships were established, but I had a steep learning curve to make the switch to online. The chief impact was fear of a platform I dreaded and losing treasured rituals in the classroom (Pt56).This disorientation caused by a sudden change in teaching routine is what Naylor and Nyanjom , but as only 10% of respondents had taught online previously, the majority needed to quickly adapt teaching styles, lesson plans, and assessment tasks to suit the online environment (Pt14). They dealt with problems such as poor internet connections, trouble-shooting students’ technical issues, and slow transitions between activities. The Pivot Report . Where learning was typically student-focused this change of roles was stressful: [Online] tutorials are weird. When in-person, I—as the tutor/facilitator—generally want to initiate a discussion and then watch the students talk it out. Online it is much more ‘me-focused’. That’s exhausting, and I don't like it (Pt39). Olivera et al. (2021) reported similar frustrations in their study of HE teachers and students in Portuguese speaking countries. Most of the time students had their cameras turned off and as such, teachers could not ascertain if they understood the concepts or skills being taught. One student offered “In many of the moments I looked at the screen, I didn't understand anything” (p. 1370) confirming this disjunct.Experienced teachers may know how to command the physical classroom, but many of our respondents expressed that Students are experiencing screen fatigue, and this makes their motivation levels hard to sustain. I have to work much harder for engagement (Pt35). For teachers whose ways of working typically rely heavily on praxis, this move to online delivery was especially challenging: I am really struggling with how to have the interactive parts of my courses remain as meaningful as they are when we are face-to-face (Pt88). One Drama teacher from Australia with over 21 years’ experience, experimented with a variety of ways to approximate Drama praxis, but without success: Students have appreciated the efforts we went to continue their Drama education but have hated it. They felt disconnected and terribly unmotivated (Pt22). The creative arts are almost exclusively experienced as praxis, “physical, embodied learning that utilises all senses” (Author 2021b under review). Davis and Phillips . And for a minority of teachers, regrettably, it was the catalyst for ending their careers:I tried to teach online as I’d always taught and it just didn't work. It was frustrating for the students and demoralizing for me. I'm a good teacher and still have much to share with young people. I sadly and reluctantly resigned at the end of the semester because I found my online teaching to be artificial, ineffective, and very unsatisfying. (Pt57)Reponses in this theme demonstrate the stress and anxiety felt by teachers as they quickly moved into an unknown space. As Kim and Asbury . And yet, not one respondent mentioned limiting their workload to working hours. Teachers with children at home felt added stress: The lack of physical separation from a workplace makes it hard to ‘turn off’. And trying to help with school while my children were home at the same time as working was a huge challenge (Pt39). Respondents knew that continuing to be available ‘24/7’ would result in jeopardising their physical and mental health: I am going to have to be mindful to have better boundaries so I don't burn out (Pt88). One teacher described being challenged mentally, physically, and practically:Mentally I am more likely to become frustrated, and even angry with colleagues, students, and administrators. I've discovered I'm not a great person to have or be around in a pandemic. Physically I am sitting far too much. I have developed a ‘zoom face’ which is a squinty-frown as I try to work out who is talking and why they're still in bed. (Pt26)Taking time for walking, working in the garden, measured breaks, hobbies, prayer, connecting with friends and loved ones, and maintaining a healthy diet were mentioned as ways to release stress. I need breaks to regroup. I need to step away from my computer and intentionally move or I get too focused and forget to eat and exercise (Pt48). Our review of current research shows a growing concern for students’ mental health, well-being, and socio-emotional needs, but there are limited studies on the impact of COVID-19 restrictions on teachers. Casacchia et al.’s . Changes in teaching strategies included breaking up longer seminars with more frequent shorter ones, staying online after sessions for those who have questions or want to talk more, offering drop in Q&A sessions, providing more comprehensive feedback on assessments, extending due dates, providing more overt demonstrations of empathy, and regular checks on students’ emotional health were trialled: There was always a well-being check in at the beginning of class and some discussion as to how COVID-19 was impacting students (Pt12).Almost exclusively, teachers let us know about the extraordinary lengths they went to support their students. This included being available outside class hours for one-on-one sessions online or on the phone: It made me seek alternative ways to deliver teaching and learning, to become more resourceful especially with accessing online resources (Pt96). And that some teaching strategies were, in fact, best suited to the online environment: Some insightful discussions have been had and we were able to invite global experts to participate in lessons. This would not have been otherwise possible (Pt96). Respondents noted skills they did not know they had or probably would not have developed if the COVID restrictions had not come into play: I am capable of managing a level of technology that I wouldn’t have chosen to do or believed that I could do (Pt92).Although online delivery is not the mode that most respondents would have chosen, there was a realisation that it came with some positives: finding a way saw teachers realising they needed to move forward by building skills and knowledge. Still impacted by the initial uncertainty, they found ways to deliver quality education with what skills they had. Teachers understood that to manage the increased workload, they needed to practice self-care. A realisation that they were capable of more than they first thought buoyed their progress.This theme of For most of [my students], the distractions were so great and the emotional toll so high…there is a general sense of chaos and anxiety that make concentration difficult (Pt76). These concerns were pervasive, as noted similarly in Kim and Asbury’s .New rituals and ways of connecting with students brought on new concerns for how they were coping emotionally and financially: Asbury’s  theme ofStudents who have internet access, materials, and do not have outside responsibilities seem to be able to engage with learning (Pt81). A teacher in the USA, however, knew her cohort of students would be disadvantaged due to the societal impacts of COVID-19:My institution serves many minority, underprivileged, and non-traditional students. Due to COVID-19, many students had to pick up extra shifts. One of my students, who works in a dollar store, told me that she worked more to fill in the gaps left behind by her colleagues who fell ill or had to provide care for children after schools closed. Another student had to pick up as many shifts as she could at her job so that she could support her family after both of her parents were laid off. Other students did not have computer and internet access at home. (Pt83)Teachers purposefully switched their priorities from content delivery and assessment, to care and compassion: Kindness, caring, and empathy are key (Pt83). They realised that some students were truly scared and needed support: This spring semester I made it very clear that the students’ health and their families’ health was #1. Anything else was secondary (Pt78). As Rawle . Also, for those in Pacific Island counties, restrictions made getting to campus to use computers insurmountable: Students cannot get to the campuses especially when they are in remote areas. Travel by bus or boat has been prohibited. Even here in the main campus, movement is restricted (Pt90). This concern for well-being was not one way. Several respondents recognised that their students now saw them differently: Some have realised that professors are human too (Pt76). They witnessed that students have become emotional, more empathetic, and more humane (Pt76) . Teachers realised that they treasured face-to-face interaction which privileges body language and nonverbal cues. I believe that teaching is about relationships, and it is far more difficult to establish relationships in an online environment (Pt56). This visceral reaction to the loss of personal connections and changes to relationships is echoed in Casacchia and colleagues’ (2021) study with HE teachers in Italy. Documenting the technical, instructive, and psychological challenges experienced, by far the most distressing impact was the feeling of speaking into the abyss of a computer screen. Their respondents acknowledged that working with students in the same physical space energised instruction and that the act of learning was far more than the transmission of knowledge, but also “emotions, feelings, relationships, and positive memories” (p. 16).There was no theme more prominently explored than that of personal connections between teachers and their students. Respondents’ stories resonated profoundly with us as we were experiencing the same yearning to be back in the classroom. By moving learning online, teachers felt they had lost the opportunity for deep spontaneous discussion and rapport building. They tell me that they miss the personal relationships and rich conversation that goes on in classrooms the most. Many are worried about speaking out online (Pt40). Our respondents drew links between the loss of emotional connection with students and their lack of academic growth. Knowing this, prompted some to find creative ways to reach out to their students. Relationship building became the priority with an emphasis on the class understanding each other as individuals: Sending a survey to students prior to the first class that draws on their unique skills and abilities and getting them to talk, bond and get to know each other prior to teaching any content. The first class is the students sharing who they are, what they want to do, their goals, dreams, passions and what they want to get out of the class (Pt18). Teachers with high-perceived emotional intelligence (the ability to accurately receive and regulate emotions) suggests Platsidou . A literacy teacher from the USA made this assessment: Teaching through an online interface has encouraged me to deeply examine my underlying theoretical understandings regarding teaching and learning. I teach through a relational lens, and so have explored ways to build relationships with students in online environment (Pt41). What stood out was a pedagogy of care and kindness for both their student and themselves: We are all in this together. Chaos is assumed and we are doing our best. Despite their shortcomings, respondents acknowledged that were still making a positive impact: Even if what I am doing is not perfect, I hope the students can see that I actually care about them and their learning. Their little emails of thanks and acknowledgement are very sustaining.For many, their identities as teachers and well-honed pedagogical styles were tested and challenged: I have learned that I can adapt and overcome under extreme pressure (Pt44);I can make the best of things and learn regardless of the obstacles (Pt56);I learnt that planning to teach online has improved my in-person teaching (Pt59);I am flexible and patient in times of stress (Pt60);I thrive on relationships in person (Pt40);I care deeply about my students’ abilities to manage online (Pt69);I am more focused on the emotional and sociocultural aspects of learning (Pt73);I have learned that teaching online isn't that scary but that I really do miss the face-to-face interaction (Pt20);I really care about my students, and there are many ways to reach students (Pt30).These storied reflections demonstrate that HE teachers hold onto what is familiar and personally important in times of stress, but proactively employ problem-focused strategies such as learning new skills and redeveloping their course material. These included emotion-focused strategies such as seeking emotional support and preferencing the effect of newly acquired pandemic pedagogies and relationships over content . We were privileged through this research to be the recipients of data stories about public and private selves, which integrate to develop narrative identity of professional selves during the early stages of the pandemic and pivot online. Storytelling opens a path for others to follow in, see themselves and their experience with, and offers space to feel the effect of the encounters we find ourselves in during the pandemic. As HE continues to shift post-pandemic, capturing the stories and the feltness of emerging pandemic pedagogies in this study has been important, because, as Kimmerer  suggestsin what ways did the immediacy of the shift to online learning during COVID-19 times impact teachers’ identities?’ we see that our respondents’ identities as teachers were impacted in multiple ways. After the initial tellings of confusion, frustration, exhaustion, vulnerability, and anxiety, the narratives refreshingly and perhaps unexpectedly moved purposefully towards understanding, meaning-making, agency, creativity, and hope, with a central emphasis on relationships and a pedagogy of care and kindness in the online space. The depth that respondents provided us in their stories demonstrates that narrative builds over time and as people share their experiences with others. Over time, suggests McLean et al., (selves create stories which in turn create selves. Whilst our respondents found the sudden shift to remote online learning challenging and stressful for many reasons, as they encountered many technological and pedagogical obstacles many of our participants told us about their agility to remain flexible, adaptable, and resilient throughout the challenges of online delivery in their situated stories. McLean et al., (Returning to the research question ‘ et al.,  in their et al.,  use the The number of participants in this study is healthy for a qualitative study, however, limitations are evident. A wider sample from higher education teachers in developing nations, countries with a large geographical area, and countries limited resources, remoteness, and susceptibility to natural disasters such as Small Island Developing States would provide a more nuanced understanding of how students without access to internet and technology devices are affected when they are not able to come to campus.We have often heard COVID-19 referred to as a ‘once in a lifetime’ pandemic that has brought about a unique teaching and learning landscape. But the reality is that we will face ongoing disruptions to learning from a whole range of sources. Fires, flooding, and other natural disasters will strike, necessitating teachers to once again pivot to remote learning. As such, there are significant findings and wide-ranging implications from this research in that this tells the story of HE teachers caring for students, of worrying about mental health challenges and how best to support learners and learning during a health crisis. It not only archives a developing understanding of agile, nimble, and caring pandemic pedagogies in HE. It tells a new story of responsive and relational education in a health crisis through vibrant reflective moments for storytelling and belonging in an online community through this research. As a result, there are implications for teaching teams, teaching practices and pedagogies, research teams and communities of practice across HE.