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Forum Play as a method for learning ethical practice: A qualitative study among Swedish health-care staff
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences. Department for Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden .
Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences, Faculty of Health Sciences, Medical Programme. Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden .
2016 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 11, no 1, 9-18 p.Article in journal (Refereed) Published
Abstract [en]

Background: In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care.

Method: Ten health-care workers participating in a Forum Play course took part in this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison.

Results: The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency.

Conclusion: The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation.

Place, publisher, year, edition, pages
Sage Publications, 2016. Vol. 11, no 1, 9-18 p.
Keyword [en]
Abuse in health care, professional-patient relation, health care, power, Forum Theater, Forum Play, constant comparative method, ethical learning
National Category
Medical Ethics
URN: urn:nbn:se:liu:diva-106233DOI: 10.1177/1477750915622032OAI: diva2:714813

At the time for thesis presentation publication was in status: Manuscript

At the time for thesis presentation manuscript was named: Forum Play as a Method for Ethical Learning: A Qualitative Study among Swedish Health Care Staff

Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2016-09-29Bibliographically 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.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1406
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-106234 (URN)10.3384/diss.diva-106234 (DOI)978-91-7519-329-8 (print) (ISBN)
Public defence
2014-05-16, Originalet, Qulturum, Ryhov County Hospital, Jönköping, 09:00 (Swedish)
Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2014-05-16Bibliographically approved

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