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Brüggemann, A. J., Forsberg, C., Colnerud, G., Wijma, B. & Thornberg, R. (2019). Bystander passivity in health care and school settings: Moral disengagement, moral distress, and opportunities for moral education. Journal of Moral Education, 48(2), 199-213
Open this publication in new window or tab >>Bystander passivity in health care and school settings: Moral disengagement, moral distress, and opportunities for moral education
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2019 (English)In: Journal of Moral Education, ISSN 0305-7240, E-ISSN 1465-3877, Vol. 48, no 2, p. 199-213Article in journal (Refereed) Published
Abstract [en]

Bystander passivity has received increased attention in the prevention of interpersonal harm, but it is poorly understood in many settings. In this article we explore bystander passivity in three settings based on existing literature: patient abuse in health care; bullying among schoolchildren; and oppressive treatment of students by teachers. Throughout the article we develop a theoretical approach that connects Obermann's unconcerned and guiltybystanders to theories of moral disengagement and moral distress respectively. Despite differences between the three settings, we show striking similarities between processes of disengagement, indicators of distress, and the constraints for intervention that bystanders identify. In relation to this, we discuss moral educational efforts that aim to strengthen bystanders’ moral agency in health care and school settings. Many efforts emphasize shared problem descriptions and collective responsibilities. As challenging as such efforts may be, there can be much to gain in terms of welfare and justice.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
bystander passivity, moral disengagement, moral distress, school, health care
National Category
Social Psychology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-150900 (URN)10.1080/03057240.2018.1471391 (DOI)000463712200004 ()2-s2.0-85049631558 (Scopus ID)
Note

Funding agencies: Swedish Research Council [2011-2478, 2013-7753, 2014-2749]

Available from: 2018-09-04 Created: 2018-09-04 Last updated: 2019-05-14Bibliographically approved
Danemalm Jägervall, C., Brüggemann, J. & Johnson, E. (2019). Gay men’s experiences of sexual changes after prostate cancer treatment: a qualitative study in Sweden. Scandinavian journal of urology, 53(1), 40-44
Open this publication in new window or tab >>Gay men’s experiences of sexual changes after prostate cancer treatment: a qualitative study in Sweden
2019 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, no 1, p. 40-44Article in journal (Refereed) Published
Abstract [en]

Background: The needs of gay men after prostate cancer treatment are becoming visible. This patient group reports a more negative impact of treatment than heterosexual men. Yet, gay men’s experiences of post-treatment sexual changes are still little explored. This study aims to determine specific concerns of gay men’s post-treatment sexual practices.

Methods: A qualitative study design was deployed using semi-structured interviews as data. Participants were purposefully sampled through advertisements and the snowball method. Eleven self-identifying gay men aged 58–81 years and treated for prostate cancer participated in interviews during 2016–2017. The interviews were transcribed, coded and thematically analysed.

Results: The analysis highlights sexual changes in relation to the physical body, identity and relations. Problematic physical changes included loss of ejaculate and erectile dysfunction. Some respondents reported continued pleasure from anal stimulation and were uncertain about the role of the prostate. These physical changes prompted reflections on age and (dis)ability. Relationship status also impacted perception of physical changes, with temporary sexual contacts demanding more of the men in terms of erection and ejaculations.

Conclusions: Gay prostate cancer survivors’ narratives about sexual changes circle around similar bodily changes as heterosexual men’s, such as erectile problems and weaker orgasms. The loss of ejaculate was experienced as more debilitating for gay men. Men who had anal sex were concerned about penetration difficulties as well as sensations of anal stimulation. Additional studies are required to better understand the role of the prostate among a diversity of men, regardless of sexuality.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Prostate cancer, sexual changes, erectile dysfunction, anejaculation, qualitative study, interviews, gay men, Sweden
National Category
Gender Studies Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-154359 (URN)10.1080/21681805.2018.1563627 (DOI)30727809 (PubMedID)
Note

Funding agencies:  Swedish Research Council [2013-8048]

Available from: 2019-02-07 Created: 2019-02-07 Last updated: 2019-07-18Bibliographically approved
Wijma, B., Persson, A., Ockander, M. & Brüggemann, J. (2019). Kränkningar i vården är vanligt förekommande: Viktigt med aktivt arbete mot att patienter kränks. Läkartidningen, 1-6
Open this publication in new window or tab >>Kränkningar i vården är vanligt förekommande: Viktigt med aktivt arbete mot att patienter kränks
2019 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, p. 1-6Article in journal (Other academic) Published
Abstract [sv]

Trots goda intentioner hos vårdpersonal upplever patienter ofta möten i vården som misslyckade. Det kan vara möten där patienten har fått en helt korrekt medicinsk behandling, men av andra anledningar upplever sig kränkt eller överkörd. Ofta lägger vårdgivare inte ens märke till att det sker. Om patienten i efterhand försöker få upprättelse är det heller inte säkert att ett sådant samtal når sitt syfte. Ämnet kränkningar i vården är tabubelagt och känslomässigt laddat. För att ge legitimitet åt insatser att hjälpa personal att motverka kränkningar behövs därför en god kunskapsbas.

Med denna utgångspunkt startades för 20 år sedan ett nytt forskningsfält om kränkningar i vården vid enheten för genus och medicin, Linköpings universitet. I denna artikel redovisar forskargruppen några av sina resultat och lärdomar.

Place, publisher, year, edition, pages
Stockholm: Läkartidningen Förlag AB, 2019
National Category
Medical Ethics Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-153881 (URN)
Available from: 2019-01-16 Created: 2019-01-16 Last updated: 2019-01-22Bibliographically approved
Brüggemann, J., Forsberg, C. & Thornberg, R. (2019). Re-negotiating agency: patients using comics to reflect upon acting in situations of abuse in health care. BMC Health Services Research, 19(1), Article ID 58.
Open this publication in new window or tab >>Re-negotiating agency: patients using comics to reflect upon acting in situations of abuse in health care
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 58Article in journal (Refereed) Published
Abstract [en]

Background

There is a growing body of international research that displays the prevalence and character of abuse in health care. Even though most of these studies are conducted from a patient perspective little is known about how patients conceptualize their agency in relation to such situations. This study aimed to explore how patients reason about their potential to act in abusive situations.

Methods

Qualitative interviews were conducted with thirteen patients in Sweden. Central in the interviews were three comics, inspired by Boal’s Forum Theatre and part of an earlier online intervention study in which the informants had participated. Each comic showed a situation in which a patient feels abused, and on the opposite side were suggestions for how the patient could act in response. Informants were asked to reflect about situations of abuse and in specific upon the comics. We used the methodology of constructivist grounded theory throughout the study, including the analysis.

Results

It appeared that the informants constantly re-negotiated their and other patients’ agency in relation to the specifics of the event, patients’ and staff’s responsibilities, and the patients’ needs and values. This process questions views of agency as fixed and self-evident, and can be understood as part of changing discourses about patients’ social role and possibilities to organize their care. Using a feminist theory of power we expected the informants to elicit instances of resistance to domination, which is central to the comics. While doing that, the informants also hinted at parallel stories of empowerment and less visible forms of agency in spite of domination.

Conclusion

The current analysis showed different ways in which the informants constantly re-negotiated their agency in potentially abusive situations. Not only did the informants engage in reflections about immediate responses to these untoward situations, they also engaged in thoughts about strategies that could protect them and counteract abuse in health care over the long-term. This opens up for future research into ways patients organize their care and identify threats and barriers to the care they need, which could be valuable knowledge for care quality improvement.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Patient agency; Abuse in health care; Constructivist grounded theory; Comics; Sweden
National Category
Medical Ethics Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-154028 (URN)10.1186/s12913-019-3902-y (DOI)000456529800006 ()30674310 (PubMedID)2-s2.0-85060371005 (Scopus ID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-03-01Bibliographically approved
Brüggemann, J., Persson, A. & Wijma, B. (2019). Understanding and preventing situations of abuse in health care: Navigation work in a Swedish palliative care setting. Social Science and Medicine, 222, 52-58
Open this publication in new window or tab >>Understanding and preventing situations of abuse in health care: Navigation work in a Swedish palliative care setting
2019 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 222, p. 52-58Article in journal (Refereed) Published
Abstract [en]

In their everyday work, health professionals find themselves in situations that they perceive to be abusive to patients. Such situations can trigger feelings of shame and guilt, making efforts to address the problem among colleagues a challenge. This article analyzes how health professionals conceptualize abusive situations, and how they develop collective learning and explore preventive strategies. It is based on an interactive research collaboration with a hospice and palliative care clinic in Sweden during 2016–2017. The empirical material consists of group discussions and participant observations collected during interactive drama workshops for all clinic staff. Based on three types of challenges in the material, identified through thematic analysis, we establish the concept of navigation work to show how health professionals prevent or find ways out of challenging and potentially abusive situations. First, the navigation of care landscapes shows how staff navigate the different territories of the home and the ward, reflecting how spatial settings construct the scope of care and what professionals consider to be potentially abusive situations. Second, the negotiation of collective navigations addresses the professionals' shared efforts to protect patients through the use of physical and relational boundaries, or mediating disrupted relationships. Third, the navigation of tensions in care highlights professionals’ strategies in the confined action space between coercing and neglecting patients who oppose necessary care procedures. Theoretically, the concept of navigation work draws upon work on care in practice, and sheds light on the particular kind of work care professionals do, and reflect on doing, in order to navigate the challenges of potentially abusive situations. By providing a perspective and shared vocabulary, the concept may also elicit ways in which this work can be verbalized, shared, and developed in clinical practice.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Sweden; Abuse in health care; Navigation work; Care practice; Interactive research; Qualitative study; Forum play
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-153753 (URN)10.1016/j.socscimed.2018.12.035 (DOI)000459838900006 ()30599436 (PubMedID)2-s2.0-85059148325 (Scopus ID)
Note

Funding agencies: Swedish Research Council [2014-2749]

Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-03-20Bibliographically approved
Brüggemann, J. (2018). Ett potentiellt problem: Om maskulinitet och behandling för prostatacancer. In: Maria Björkman (Ed.), Prostatan – det ständiga gisslet?: Mannen och prostatan i kultur, medicin och historia (pp. 89-103). Nordic Academic Press
Open this publication in new window or tab >>Ett potentiellt problem: Om maskulinitet och behandling för prostatacancer
2018 (Swedish)In: Prostatan – det ständiga gisslet?: Mannen och prostatan i kultur, medicin och historia / [ed] Maria Björkman, Nordic Academic Press, 2018, p. 89-103Chapter in book (Other academic)
Place, publisher, year, edition, pages
Nordic Academic Press, 2018
National Category
Cultural Studies History Public Health, Global Health, Social Medicine and Epidemiology Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-154003 (URN)9789188661630 (ISBN)9789188661647 (ISBN)
Available from: 2019-01-22 Created: 2019-01-22 Last updated: 2019-08-06Bibliographically approved
Brüggemann, J. (2017). Exploring patient strategies in response to untoward healthcare encounters. Nursing Ethics, 24(2), 190-197
Open this publication in new window or tab >>Exploring patient strategies in response to untoward healthcare encounters
2017 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 2, p. 190-197Article in journal (Refereed) Published
Abstract [en]

Background: Increasing attention to patients’ rights and their ability to choose their healthcare provider have changed the way patients can respond to untoward, disempowering and abusive healthcare encounters. These responses are often seen as crucial for quality improvement, yet they are little explored and conceptualized.

Objective: To explore patients’ potential responses to untoward healthcare encounters and looking at their possible consequences for care quality improvement as well as for the individual patient.

Research design: The article is structured looking at two primary strategies: patient exit (leaving a healthcare provider) and patient voice (expressing grievances), derived from Hirschman (1970). These strategies were explored by the use of theoretical and empirical literature and applied to an individual patient case. The case functions as a pedagogical tool to illustrate and problematize what exit and voice strategies can mean for a single patient.

Ethical considerations: The patient case is my version of a generalized scenario that is described elsewhere. It does not represent an individual patient’s story, but aims to be realistic and recognizable.

Findings and conclusion: Based on the existing literature, it is hypothesized that, in their current form, exit and voice strategies have a limited effect on care quality and can come at a price for patients. However, both strategies may be of value to patients and providers. Therefore, the healthcare system could empower patients to engage in action and could further develop ways for providers to effectively use patients’ responses to improve practice and find ways to prevent patients from untoward experiences in healthcare.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Patient voice, Patient exit, Quality of health care, Patient dissatisfaction, Untoward encounters, Abuse in health care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-124696 (URN)10.1177/0969733015591074 (DOI)000397917600007 ()26174469 (PubMedID)
Note

Funding agencies: Swedish Research Council [2011-2478]

Available from: 2016-02-10 Created: 2016-02-10 Last updated: 2018-11-15Bibliographically approved
Simmons, J., Brüggemann, A. J. & Swahnberg, K. (2016). Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence. BMJ Open, 6(6), Article ID e010847.
Open this publication in new window or tab >>Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, article id e010847Article in journal (Refereed) Published
Abstract [en]

Despite associations between being subjected to violence and ill-health being well known, most victims have never told health care professionals about their victimisation. Although both experiences of victimisation and help-seeking behaviour are gendered, male victims’ encounters with the health care system are under-researched. The aim of this study was to develop a theoretical model concerning male victims’ processes of disclosing experiences of being subjected to violence to health care professionals in Sweden. Constructivist grounded theory was used. Twelve men who had reported experiences of emotional, sexual, and/or physical violence by any type of perpetrator in an earlier quantitative study were interviewed. Conflicting thoughts within the men affected their likelihood of disclosing their victimisation. For example, a sense of urgency to seek help increased their likelihood, whereas shame and fear of negative consequences decreased their likelihood. Conformity to hegemonic masculinity had a strong negative influence, and was tipping the men towards a low likelihood of disclosing victimisation. Health care professionals strongly influence the disclosing process. For example, a good patient-provider relationship would help the men disclose, whereas a strong factor hindering disclosure was professionals’ adherence to gender norms, thus neither validating men’s experiences of violence nor acknowledging their psychological suffering.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2016
Keywords
Sweden; Violence; Abuse; Help-seeking; Screening; Gender; Masculinity; Constructivist Grounded Theory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-114678 (URN)10.1136/bmjopen-2015-010847 (DOI)000380237100066 ()
Note

The status of this article was previous manuscript.

Funding agencies: Region Ostergotland, Sweden [LIO-340221, LIO-514621]

Available from: 2015-03-02 Created: 2015-03-02 Last updated: 2018-11-15Bibliographically approved
Danemalm Jägervall, C., Gunnarsson, B. & Brüggemann, J. (2016). Orgasmen förändras negativt men uteblivet ejakulat ingen stor förlust [Patients’ experiences of orgasm changes and loss of ejaculation after radical prostatectomy]: Tio män om orgasmupplevelse och ejakulationsbortfall efter radikal prostatektomi. Läkartidningen, 113(3), 1470-1472
Open this publication in new window or tab >>Orgasmen förändras negativt men uteblivet ejakulat ingen stor förlust [Patients’ experiences of orgasm changes and loss of ejaculation after radical prostatectomy]: Tio män om orgasmupplevelse och ejakulationsbortfall efter radikal prostatektomi
2016 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, no 3, p. 1470-1472Article in journal (Refereed) Published
Abstract [en]

Patients' experiences of orgasm changes and loss of ejaculation after radical prostatectomy   In this study we report on men's experiences of orgasm changes and loss of ejaculation after radical prostatectomy. Ten men, all recruited through a Swedish hospital, were interviewed and data was analyzed using qualitative content analysis. The results showed that the experience of orgasm has weakened but that the loss of ejaculation was not perceived as a loss per se. However, the risk of urine release during orgasm was troublesome and inhibiting. These challenges were framed within an existential narrative about sexuality, as expressed in preoperative sexual farewell rituals and postoperative feelings of ambivalence and regret. These findings can be used in the design of patient information and for sexual rehabilitation treatment.

Abstract [sv]

Radikal prostatektomi, den vanligaste kurativa behandlingen vid prostatacancer i Sverige, orsakar sexuella komplikationer såsom erektil dysfunktion, ejakulationsförlust och ofta en förändrad orgasmkänsla. I dag ökar intresset för rehabilitering i cancervården och i det nationella vårdprogrammet för prostatacancer betonas sexologisk rehabilitering.

Forskning inom detta område är främst kvantitativ med störst fokus på erektil dysfunktion. Även den kvalitativa forskning som finns har huvudsakligen kretsat kring erektil dysfunktion. Denna studies syfte var att undersöka hur patienter efter kirurgisk behandling vid prostatacancer upplever orgasmförändring och ejakulationsförlust.

Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2016
National Category
Psychology Health Sciences
Identifiers
urn:nbn:se:liu:diva-134903 (URN)27622759 (PubMedID)
Available from: 2017-03-01 Created: 2017-03-01 Last updated: 2018-11-15Bibliographically approved
Wijma, B., Zbikowski, A. & Brüggemann, J. (2016). Silence, shame and abuse in health care: theoretical development on basis of an intervention project among staff. BMC Medical Education, 16(75)
Open this publication in new window or tab >>Silence, shame and abuse in health care: theoretical development on basis of an intervention project among staff
2016 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, no 75Article in journal (Refereed) Published
Abstract [en]

As health care exists to alleviate patients suffering it is unacceptable that it inflicts unnecessary suffering on patients. We therefore have developed and evaluated a drama pedagogical model for staff interventions using Forum Play, focusing on staffs experiences of failed encounters where they have perceived that the patient felt abused. In the current paper we present how our preliminary theoretical framework of intervening against abuse in health care developed and was revised during this intervention. During and after the intervention, five important lessons were learned and incorporated in our present theoretical framework. First, a Forum Play intervention may break the silence culture that surrounds abuse in health care. Second, organizing staff training in groups was essential and transformed abuse from being an individual problem inflicting shame into a collective responsibility. Third, initial theoretical concepts "moral resources" and "the vicious violence triangle" proved valuable and became useful pedagogical tools during the intervention. Four, the intervention can be understood as having strengthened staffs moral resources. Five, regret appeared to be an underexplored resource in medical training and clinical work. The occurrence of abuse in health care is a complex phenomenon and the research area is in need of theoretical understanding. We hope this paper can inspire others to further develop theories and interventions in order to counteract abuse in health care.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2016
Keywords
Sweden; Abuse in health care; Forum play; Silence; Shame; Regret; Health care intervention; Professional education; Moral learning
National Category
Clinical Medicine Other Social Sciences
Identifiers
urn:nbn:se:liu:diva-126252 (URN)10.1186/s12909-016-0595-3 (DOI)000371126800004 ()26922381 (PubMedID)
Note

Funding Agencies|Swedish Research Council [2006-2503, 2009-2380, 2011-2478, 2014-2749]

Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2018-11-15
Organisations
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ORCID iD: ORCID iD iconorcid.org/0000-0002-1514-677x

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