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Brüggemann, J., Guntram, L. & Nedlund, A.-C. (2023). On difficult patients and informal complaints.
Open this publication in new window or tab >>On difficult patients and informal complaints
2023 (English)Other (Other (popular science, discussion, etc.))
Abstract [en]

Thinking critically about the role of complaint in patient care, Jelmer Brüggemann, Lisa Guntram and Ann-Charlotte Nedlund explore the ’difficult patient’ as a medical humanities concept.

Keywords
Medical humanities, care practices, difficult patient, complaints
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-192045 (URN)
Funder
Swedish Research Council, 2020-01594
Available from: 2023-02-28 Created: 2023-02-28 Last updated: 2023-03-07Bibliographically approved
Brüggemann, J., Guntram, L. & Nedlund, A.-C. (2023). The “Difficult Patient”: Dominant Logics and Misfits in Medicine. In: Pranee Liamputtong (Ed.), Handbook of Social Sciences and Global Public Health: (pp. 1-14). Cham: Springer
Open this publication in new window or tab >>The “Difficult Patient”: Dominant Logics and Misfits in Medicine
2023 (English)In: Handbook of Social Sciences and Global Public Health / [ed] Pranee Liamputtong, Cham: Springer, 2023, p. 1-14Chapter in book (Other academic)
Abstract [en]

Medicine is organized around specific kinds of patients. In the cross-section of overarching biomedical narratives, international and national regulations and guidelines, and local practices, a particular kind of “ideal” patient is produced. The ideal patient embraces the larger biomedical paradigm, fits standardized diagnostic or treatment protocols, and behaves in expected and respectful ways. At the same time, its downside is created. Modern medicine’s narrow pathways create all sorts of “difficult patients.” Rather than focusing on the “difficult patient” as a psychological or relational struggle for individual care professionals or patients – a common focus in medical literature and debate – this chapter approaches the “difficult patient” as a phenomenon inherent in the ways in which medicine is organized. It shows how the difficult patient can provide an analytic lens through which individuals can see health care norms and logics in play. In particular, the chapter discusses how the difficult patient comes into being in “misfits” between dominant logics in medicine and individual patient lives and needs.

Place, publisher, year, edition, pages
Cham: Springer, 2023
Keywords
Difficult patient, Noncompliance, Sick role, Standardization, Normalization, Active patient, Logics of care
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-191021 (URN)10.1007/978-3-030-96778-9_138-1 (DOI)9783030967789 (ISBN)
Funder
Swedish Research Council, 2020-01594
Available from: 2023-01-16 Created: 2023-01-16 Last updated: 2023-02-06Bibliographically approved
Brüggemann, J. (2021). Redefining masculinity – Men’s repair work in the aftermath of prostate cancer treatment. Health Sociology Review, 30(2), 143-156
Open this publication in new window or tab >>Redefining masculinity – Men’s repair work in the aftermath of prostate cancer treatment
2021 (English)In: Health Sociology Review, ISSN 1446-1242, E-ISSN 1839-3551, Vol. 30, no 2, p. 143-156Article in journal (Refereed) Published
Abstract [en]

Treatments for prostate cancer have many potential side effects such as a loss of erection, weaker orgasms, and incontinence. These are all bodily changes that may challenge dominant masculine ideals. In this article, I use Persson’s repair work to describe how men tackle these side effects, and I describe the trouble their repair work elicits in terms of masculinity. I analyse interviews with eleven Swedish men, all treated for prostate cancer, and show that such work is done in three ways. Bodily repair work elicits the work men do to restore bodily functions, often through medical technologies. Relational repair work describes how relations with (potential) others shape men's bodily and sexual concerns, and the ways relations redefine such concerns. Age marking as repair emphasises how age is used in the redefinitions of norms about masculinities and aging bodies, both in relation to oneself and others. The analysis highlights how men's repair work is multifaceted, and is performed against the backdrop of dominant discourses on masculinity, medicine and old age. The analysis of such repair work is valuable to research on how masculinity is constructed in the light of treatment side effects and older age.

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Sweden; prostate cancer; masculinity; repair work; bodily changes; side effects
National Category
Gender Studies
Identifiers
urn:nbn:se:liu:diva-170256 (URN)10.1080/14461242.2020.1820367 (DOI)000572795500001 ()
Note

Funding agencies:  Swedish Research CouncilSwedish Research Council [2013-8048]

Available from: 2020-10-06 Created: 2020-10-06 Last updated: 2022-10-28
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
Show others...
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: 2020-04-27Bibliographically 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)000471933500009 ()30727809 (PubMedID)
Note

Funding agencies:  Swedish Research Council [2013-8048]

Available from: 2019-02-07 Created: 2019-02-07 Last updated: 2021-03-07Bibliographically approved
Wijma, B., Persson, A., Ockander, M. & Brüggemann, J. (2019). Kränkningar i vården är vanligt förekommande [Abuse in healthcare – Lessons learned during two decades of research]: 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 [Abuse in healthcare – Lessons learned during two decades of research]: Viktigt med aktivt arbete mot att patienter kränks
2019 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, p. 1-6Article, review/survey (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.

Abstract [sv]

Patients’ experience of abuse in health care (AHC) is common, and may cause long-lasting suffering. In Sweden, lifetime prevalence is estimated at 20 per cent among female patients and 8 per cent among male patients, and a background of other abuse is a risk factor. Most health care staff have experience of patients who have been abused, but the topic is surrounded by silence from both patients and caregivers. Models for training staff in groups have been evaluated and a more proactive stance can be fostered. Department heads and health care authorities are responsible for providing staff with options to counteract AHC. Caregivers need training in how to carry out consultations with patients who say they have been abused in health care, and this training should be included in efforts to increase quality of care. Changes are within reach but educational efforts are urgent.

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: 2020-05-01Bibliographically approved
Brüggemann, J., Petersson, C., Nilsen, A. & Gollenia, S. (2019). Människan i medicinen: En utställning om medicinsk humaniora. Linköping
Open this publication in new window or tab >>Människan i medicinen: En utställning om medicinsk humaniora
2019 (Swedish)Artistic output (Unrefereed)
Alternative title[en]
The Human in Medicine
Abstract [sv]

Vad händer med människors bild av sig själva och sin kropp när de blir del av en medicinsk verksamhet? Hur ändras synen på människan genom medicinsk utveckling? Och vilka föreställningar om människor styr vården och dess organisation?

Medicinsk humaniora och samhällsvetenskap är ett tvärvetenskapligt forskningsfält som studerar komplexa relationer mellan hälsa, sjukdom, medicinsk utveckling och kultur. Ämnet kan förse kliniskt verksamma och studenter inom medicin- och vårdutbildningar med nya perspektiv på centrala frågor kring människors hälsa eller vårdens vardag – frågor som inte alltid får utrymme i en tid där vården tvingas till effektivisering och medicinsk utveckling sker i allt snabbare takt.

Människan i medicinen lyfter fram några aktuella forskningsprojekt vid Linköpings universitet, avslutade såväl som nystartade.

Abstract [en]

What happens with understandings of the self and the body when people become part of medical practices? How do medical developments change the ways in which we define human beings and what it is to be human? And what ideas and assumptions about people govern health care systems and its organization?

The medical humanities is an interdisciplinary research field that studies complex relations between health, disease, medical developments and culture. The field can offer health professionals and students in medical and care programmes new perspectives on key questions surrounding human health and everyday care – questions that not always get room in a time where health care systems are forced into efficiency measures, and medicine develops in an increasingly rapid pace.

The Human in Medicine is an exhibition that shines a light on a few research projects within the field of the medical humanities and social sciences at Linköping University.

Place, publisher, year, pages
Linköping: , 2019
Keywords
medicinsk humaniora; tvärvetenskapliga studier inom samhällsvetenskap
National Category
Social Sciences Interdisciplinary Other Humanities not elsewhere specified Health Care Service and Management, Health Policy and Services and Health Economy Medical Ethics
Identifiers
urn:nbn:se:liu:diva-171413 (URN)
Funder
Linköpings universitet, Verifiering för Nyttiggörande
Note

Available from: 2020-11-16 Created: 2020-11-16 Last updated: 2022-07-14Bibliographically 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, 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: 2022-09-15Bibliographically 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
Wijma, B., Persson, A., Ockander, M. & Brüggemann, J. (2019). Upprepad utsatthet - bakgrund av övergrepp hos kvinnor och män och risken att uppleva kränkningar i vården. Socialmedicinsk Tidskrift, 96(4), 499-518
Open this publication in new window or tab >>Upprepad utsatthet - bakgrund av övergrepp hos kvinnor och män och risken att uppleva kränkningar i vården
2019 (Swedish)In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 96, no 4, p. 499-518Article in journal (Refereed) Published
Abstract [en]

Forskning visar att var sjätte kvinnlig och var trettonde manlig patient har upplevt kränkningar i vården. En bakgrund av övergrepp ökar risken att som vuxen uppleva sig kränkt i vården. 

Detta samband analyseras i artikeln liksom dess orsaker och konsekvenser för patienter och vårdgivare. På basen av mångårig interventionsforskning diskuteras även hur vården på både strukturell och individuell nivå kan förhindra att patienter kränks och speciellt patienter med en bakgrund av övergrepp. 

Ett stort ansvar vilar på vårdens alla ledningsnivåer, från myndighet till klinik, för att skapa förutsättningar i form av tid, kunskap och verktyg så att vårdgivare kan agera mot att patienter kränks. Artikeln beskriver ett antal sådana verktyg.

Place, publisher, year, edition, pages
Stiftelsen Socialmedicinsk Tidskrift, 2019
Keywords
Vårdmöten; traumatiserade patienter; strukturellt/kulturellt våld; interventionsforskning; prevention
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-161050 (URN)
Available from: 2019-10-10 Created: 2019-10-18
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1514-677x

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