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Counteracting Abuse in Health Care: A Quantitative Evaluation of an Intervention with Forum Play for Staff
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: In their lifetime, 13%–28% of female patients in the Nordic countries seeking gynecological health care have reported abuse by staff in a health care setting (AHC). Besides suffering, AHC can cause patients to avoid contacting the health care system. Thus, interventions are clearly needed. In this article, we report a drama intervention method among health care staff and study to what extent the intervention increased the staff’s awareness of AHC and their ability to take action against it.

Design: Pre-/post-test measurement by means of self-reported questionnaires with a longterm follow-up one year after the intervention. Questionnaires were distributed at four measuring times.

Setting: A women’s clinic in Sweden.

Participants: All staff at the target clinic were invited to participate in the intervention and received the questionnaires (n=137). Of those 136 had the possibility to participate in the intervention. A total of 92 staff members (67%) returned at least two questionnaires. 76 (56%) participated in the intervention, of which 61 (80%) returned at least one questionnaire.

Intervention: The drama intervention was based on Forum Play (FP), a form of improvised role-play based on the pedagogy of Augusto Boal. During one year, 2008–2009, 16 half-day FP workshops focusing on AHC were conducted at the target clinic. Participation was voluntary.

Primary outcome measures: 1) The number of reported occasions when staff heard of or were involved in AHC. 2) FP participants’ self-reported ability to act in AHC-related situations.

Results: No change could be seen in the number of occasions of AHC reported by staff between baseline and one year after the intervention. However, an increase of the participants’ ability to act in AHC-related situations was seen.

Conclusions: Health care staff’s participation in FP workshops can increase their ability to take action in AHC situations, but probably does not affect their awareness of AHC.

Place, publisher, year, edition, pages
2014.
Keyword [en]
Abuse in health care, interactive theater, Forum Play, Forum Theater, health care staff, professional-patient relation, moral resources
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-106232OAI: oai:DiVA.org:liu-106232DiVA: diva2:714811
Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2015-03-26Bibliographically approved
In thesis
1. Counteracting Abuse in Health Care from a Staff Perspective: Ethical Aspects and Practical Implications
Open this publication in new window or tab >>Counteracting Abuse in Health Care from a Staff Perspective: Ethical Aspects and Practical Implications
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Abuse of patients by health care staff (AHC) is a cause of unnecessary suffering, which is inconsonant with the premise in medicine of not doing harm to the patient. The understanding of AHC in this thesis is considered two-dimensional: as a patient’s subjective experience and as violation of a patient’s dignity. Patients’ experiences of these events are rather well studied and are characterized by feelings of neglect and a loss of their human value. However, little is known about staff’s perspectives on AHC and what they can do to counteract it.

Aim: The overall aim of this thesis is to approach AHC from the perspective of health care staff in order to develop and test a model for enabling health care staff to recognize and take action in situations where AHC is about to happen and to handle it professionally once it has happened.

Methods: To explore professionals’ formal perspectives on AHC, five sets of ethical guidelines for staff working within gynecology and obstetrics were examined in study I, using an analytical framework based on empirical studies regarding issues related to AHC. Data for studies II and III were collected at a women’s clinic that had chosen to host an intervention model based on Forum Play (FP) as a method for counteracting AHC. In FP, an improvisational theater method, based on Boal’s Forum Theater, staff together stage problematic situations from their own experience and test different ways of acting. In study II, qualitative interviews with 21 staff members from the target clinic were conducted, to capture the staff’s perception of AHC before the intervention. Study III evaluated the impact of 16 FP workshops by means of questionnaires focusing on the occurrences of AHC and the perceived effects of FP, sent to all staff (n=137) before, during, and after the intervention. In study IV, ten participants of an FP course, consisting of a mixed group of employees working within health care, were interviewed about their experiences of the FP course.

Results: In study I, it was shown that all guidelines failed to address issues related to AHC, mainly structural issues such as power imbalances between professionals. In study II, the staff’s described perception of AHC was best categorized as ethical lapses, integrating theoretical descriptions of AHC with a defensive staff-centered position that rejected responsibility for AHC. In study III, no indication of an increased awareness of AHC was found, but an increase in the staff’s ability to act in situations with a moral dilemma was confirmed, even one year after the intervention. The findings of study IV suggest that FP has the potential to develop a response ability, enabling staff to become active in AHC situations. The power to intervene when witnessing AHC was emphasized.

Conclusions: Assuming that clinical practice is a moral activity with the good of the patient as its end, it is important for staff to be able to understand AHC from the patient’s perspective. To accomplish this, even structural aspects such as power imbalances between professionals have to be considered. By failing to address these important aspects, ethical guidelines appear to be a limited resource for helping to counteract AHC. FP enables staff participants to adopt a patient’s perspective and to develop an understanding of their power and responsibility to act when in a situation involving AHC. Furthermore FP seems to provide a useful tool for staff learning to display and overcome structural obstacles in order to intervene when witnessing AHC. If counteracting AHC is understood as a matter of acting professionally, practical training such as FP needs to be prioritized.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 76 plus Appendix p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1406
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-106234 (URN)10.3384/diss.diva-106234 (DOI)978-91-7519-329-8 (ISBN)
Public defence
2014-05-16, Originalet, Qulturum, Ryhov County Hospital, Jönköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2014-05-16Bibliographically approved

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Brüggemann, A. JelmerWijma, BarbroSwahnberg, Katarina

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