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Silence, shame and abuse in health care: theoretical development on basis of an intervention project among staff
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, 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 Medicine and Health Sciences. Ryhov County Hospital, Sweden.
Linköping University, The Tema Institute, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
2016 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, no 75Article in journal (Refereed) PublishedText
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. Vol. 16, no 75
Keyword [en]
Sweden; Abuse in health care; Forum play; Silence; Shame; Regret; Health care intervention; Professional education; Moral learning
National Category
Clinical Medicine Other Social Sciences
URN: urn:nbn:se:liu:diva-126252DOI: 10.1186/s12909-016-0595-3ISI: 000371126800004PubMedID: 26922381OAI: diva2:913446

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

Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2016-04-06

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Wijma, BarbroZbikowski, AnkeBrüggemann, Jelmer
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Division of Clinical SciencesFaculty of Medicine and Health SciencesDepartment of Gynaecology and Obstetrics in LinköpingTechnology and Social ChangeFaculty of Arts and Sciences
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