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Patients’ silence towards the healthcare system after ethical transgressions by staff: associations with patient characteristics in a cross-sectional study among Swedish female patients
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
2012 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 6Article in journal (Refereed) Published
Abstract [en]

Objectives To identify which patient characteristics are associated with silence towards the healthcare system after experiences of abusive or ethically wrongful transgressive behaviour by healthcare staff.

Design Cross-sectional questionnaire study using the Transgressions of Ethical Principles in Health Care Questionnaire.

Setting A women's clinic in the south of Sweden.

Participants Selection criteria were: consecutive female patients coming for an outpatient appointment, ≥18-year-old, with the ability to speak and understand the Swedish language, and a known address.

Questionnaires were answered by 534 women (60%) who had visited the clinic, of which 293 were included in the present study sample.

Primary outcome measure How many times the respondent remained silent towards the healthcare system relative to the number of times the respondent spoke up.

Results Associations were found between patients’ silence towards the healthcare system and young age as well as lower self-rated knowledge of patient rights. Both variables showed independent effects on patients’ silence in a multivariate model. No associations were found with social status, country of birth, health or other abuse.

Conclusions The results offer opportunities for designing interventions to stimulate patients to speak up and open up the clinical climate, for which the responsibility lies in the hands of staff; but more research is needed.

Place, publisher, year, edition, pages
BMJ Publishing Group: BMJ Open / BMJ Journals , 2012. Vol. 2, no 6
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-90217DOI: 10.1136/bmjopen-2012-001562ISI: 000315081400059OAI: oai:DiVA.org:liu-90217DiVA: diva2:612334
Note

Funding Agencies|Swedish Research Council|2009-2380|Nordic Council of Ministers||

Available from: 2013-03-21 Created: 2013-03-21 Last updated: 2017-12-06
In thesis
1. Toward an Understanding of Abuse in Health Care: A Female Patient Perspective
Open this publication in new window or tab >>Toward an Understanding of Abuse in Health Care: A Female Patient Perspective
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background. High numbers of incidents of abuse in health care (AHC) have been reported by patients in Sweden. In questionnaire studies (n=9600), every fifth Swedish woman and every tenth Swedish man reported any lifetime experience of AHC, and a majority reported suffering from their experiences. Female patients with experiences of AHC described them as experiences of being nullified, and male patients as experiences of being mentally pinioned. Little is known about why AHC occurs and how it can prevail in a health care system that aims to relieve patients’ suffering.

Aim. The overall aim of the thesis was to bring understanding to what AHC is and to start exploring what contributes to its occurrence, focusing on a female patient perspective.

Methods. In study I, a concept analysis of AHC was conducted based on the concept’s appearance in scientific literature and through case studies. Also, AHC was demarcated against the related concepts patient dissatisfaction, medical error, and personal identity threat, in order to analyze differences and similarities with these concepts. For studies II and III the Transgressions of Ethical Principles in Health Care Questionnaire (TEP) was developed to measure to what extent female patients remain silent toward the health care system after having experienced abusive or wrongful ethical transgressions in the Swedish health care system. It was hypothesized that to a high degree female patients remain silent toward the health care system after such experiences, and this lack of feedback may in turn contribute to the hampering of structural change toward better encounters. The questionnaire was answered by female patients recruited at a women’s clinic in the south of Sweden (n=530). Study IV built on a constructed grounded theory design and included informants who reported experiences of AHC in TEP (n=12). The interviews focused on the informants’ stories of what contributed to their experiences of AHC.Results.

Results. Based on the concept analysis, AHC was described as patients’ subjective experiences in health care of encounters devoid of care, in which they experienced suffering and loss of their human value. Study II showed that a majority of the female patients who perceived one or more transgressions as abusive or wrongful remained silent about at least one of them (70.3%). In 60% of all cases, patients remained silent about abusive or wrongful events. In study III it was examined whether patients remaining silent could be associated with any patient characteristics. Remaining silent was only found to be associated with younger age and a lower self-rated knowledge of patient rights. In study IV, female patients’ stories of what contributed to their experiences of AHC were analyzed. This was best characterized as a process where the patient loses power struggles. According to these patients, not only their vulnerability, but also their level of competence contributed to staff’s unintended use of domination techniques by which they felt abused.

Conclusions. As AHC is defined from patients’ subjective experiences it is necessary for the prevention of AHC to listen to patients’ stories and complaints. The prevalence of female patients’ silence after abusive events could be worrying, as it constitutes a loss of essential feedback for the health care system. Patients do not bear responsibility for the quality of health care processes, but their knowledge may be very valuable for structural improvement of these processes and could be valued as such. Clinical interventions that stimulate these patients to speak up, accompanied by health care staff’s reflections on how to respond to patients speaking up, must therefore be explored.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 73 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1318
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79334 (URN)978-91-7519-846-0 (ISBN)
Public defence
2012-09-07, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
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Supervisors
Available from: 2012-07-10 Created: 2012-07-10 Last updated: 2013-06-18Bibliographically approved

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Brüggemann, A. JelmerSwahnberg, Katarina

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