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  • 1. Order onlineBuy this publication >>
    Brüggemann, A. Jelmer
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Toward an Understanding of Abuse in Health Care: A Female Patient Perspective2012Doctoral 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.

    List of papers
    1. Abuse in health care: a concept analysis
    Open this publication in new window or tab >>Abuse in health care: a concept analysis
    2012 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, p. 123-132Article in journal (Refereed) Published
    Abstract [en]

    Aims and objectives:  To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is different from the related concepts of medical error, patient satisfaction and personal identity threat.

    Background:  Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated.

    Design:  Concept analysis as developed by Walker and Avant.

    Method:  The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care, four on medical error, six on patient satisfaction and three on personal identity threat.

    Results:  Abuse in health care is defined by patients’ subjective experiences of encounters with the health care system, characterized by devoid of care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. We also found differences with the aforementioned related concepts: medical error does not share the patients’ perspective, and patient satisfaction does not offer room for patients’ abusive experiences. The concept of personal identity threat shares all attributes with abuse in health care, but it lacks an antecedent that signifies the social structures underlying the phenomenon.

    Conclusions:  Abuse in health care covers a phenomenon that has severe consequences but is invisible if seen from a medical error or patient satisfaction perspective.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2012
    Keywords
    abuse in health care, concept analysis, medical error, patient satisfaction, Walker and Avant, kränkningar i vården, begreppsanalys, medicinska misstag, patienttillfredsställelse
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-75207 (URN)10.1111/j.1471-6712.2011.00918.x (DOI)000300567200016 ()
    Available from: 2012-02-21 Created: 2012-02-21 Last updated: 2018-11-15
    2. Patients’ silence following healthcare staff’s ethical transgressions
    Open this publication in new window or tab >>Patients’ silence following healthcare staff’s ethical transgressions
    2012 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 19, no 6, p. 750-763Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to examine to what extent patients remained silent to the health care system after they experienced abusive or wrongful incidents in health care. Female patients visiting a women’s clinic in Sweden (n = 530) answered the Transgressions of Ethical Principles in Health Care Questionnaire (TEP), which was constructed to measure patients’ abusive experiences in the form of staff’s transgressions of ethical principles in health care. Of all the patients, 63.6% had, at some point, experienced staff’s transgressions of ethical principles, and many perceived these events as abusive and wrongful. Of these patients, 70.3% had remained silent to the health care system about at least one transgression. This silence is a loss of essential feedback for the health care system and should not automatically be interpreted as though patients are satisfied.

    Place, publisher, year, edition, pages
    Sage Publications, 2012
    Keywords
    abuse in health care, patient silence, patient satisfaction, principle-based ethics, quality of care, TEP
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-77147 (URN)10.1177/0969733011423294 (DOI)000311221600005 ()
    Note

    funding agencies|Nordic Council of Ministers||Swedish Research Council|2009-2380|

    Available from: 2012-05-07 Created: 2012-05-07 Last updated: 2018-11-15Bibliographically approved
    3. Patients’ silence towards the healthcare system after ethical transgressions by staff: associations with patient characteristics in a cross-sectional study among Swedish female patients
    Open this publication in new window or tab >>Patients’ silence towards the healthcare system after ethical transgressions by staff: associations with patient characteristics in a cross-sectional study among Swedish female patients
    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
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-90217 (URN)10.1136/bmjopen-2012-001562 (DOI)000315081400059 ()
    Note

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

    Available from: 2013-03-21 Created: 2013-03-21 Last updated: 2018-11-15
    4. What contributes to abuse in health care? A grounded theory of female patients’ stories
    Open this publication in new window or tab >>What contributes to abuse in health care? A grounded theory of female patients’ stories
    2013 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 3, p. 404-412Article in journal (Refereed) Published
    Abstract [en]

    Background

    In Sweden, 20% of female patients have reported lifetime experiences of abuse in any health care setting. Corresponding prevalence among male patients is estimated to be 8%. Many patients report that they currently suffer from these experiences. Few empirical studies have been conducted to understand what contributes to the occurrence of abuse in health care.

    Objectives

    To understand what factors contribute to female patients’ experiences of abuse in health care.

    Design

    Constructivist grounded theory approach.

    Settings

    Women's clinic at a county hospital in the south of Sweden.

    Participants

    Twelve female patients who all had reported experiences of abuse in health care in an earlier questionnaire study.

    Methods

    In-depth interviews.

    Results

    The analysis resulted in the core category, the patient loses power struggles, building on four categories: the patient's vulnerability, the patient's competence, staff's use of domination techniques, and structural limitations. Participants described how their sensitivity and dependency could make them vulnerable to staff's domination techniques. The participants’ claim for power and the protection of their autonomy, through their competence as patients, could catalyze power struggles.

    Conclusions

    Central to the participants’ stories was that their experiences of abuse in health care were preceded by lost power struggles, mainly through staff's use of domination techniques. For staff it could be important to become aware of the existence and consequences of such domination techniques. The results indicate a need for a clinical climate in which patients are allowed to use their competence.

    Place, publisher, year, edition, pages
    Elsevier, 2013
    Keywords
    Grounded theory, Patient abuse, Power, Professional misconduct, Qualitative research, Quality of health care, Sweden
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-90196 (URN)10.1016/j.ijnurstu.2012.10.003 (DOI)000315239700012 ()
    Note

    Funding Agencies|Swedish Research Council|2009-2380|

    Available from: 2013-03-21 Created: 2013-03-21 Last updated: 2018-11-15
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    Toward an Understanding of Abuse in Health Care: A Female Patient Perspective
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  • 2.
    Brüggemann, A. Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Patients’ silence towards the healthcare system after ethical transgressions by staff: associations with patient characteristics in a cross-sectional study among Swedish female patients2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 6Article in journal (Refereed)
    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.

    Download full text (pdf)
    fulltext
  • 3.
    Brüggemann, A. Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    What contributes to abuse in health care? A grounded theory of female patients’ stories2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 3, p. 404-412Article in journal (Refereed)
    Abstract [en]

    Background

    In Sweden, 20% of female patients have reported lifetime experiences of abuse in any health care setting. Corresponding prevalence among male patients is estimated to be 8%. Many patients report that they currently suffer from these experiences. Few empirical studies have been conducted to understand what contributes to the occurrence of abuse in health care.

    Objectives

    To understand what factors contribute to female patients’ experiences of abuse in health care.

    Design

    Constructivist grounded theory approach.

    Settings

    Women's clinic at a county hospital in the south of Sweden.

    Participants

    Twelve female patients who all had reported experiences of abuse in health care in an earlier questionnaire study.

    Methods

    In-depth interviews.

    Results

    The analysis resulted in the core category, the patient loses power struggles, building on four categories: the patient's vulnerability, the patient's competence, staff's use of domination techniques, and structural limitations. Participants described how their sensitivity and dependency could make them vulnerable to staff's domination techniques. The participants’ claim for power and the protection of their autonomy, through their competence as patients, could catalyze power struggles.

    Conclusions

    Central to the participants’ stories was that their experiences of abuse in health care were preceded by lost power struggles, mainly through staff's use of domination techniques. For staff it could be important to become aware of the existence and consequences of such domination techniques. The results indicate a need for a clinical climate in which patients are allowed to use their competence.

    Download full text (pdf)
    fulltext
  • 4.
    Brüggemann, Adrianus Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Forsberg, Camilla
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Colnerud, Gunnel
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Thornberg, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Bystander passivity in health care and school settings: Moral disengagement, moral distress, and opportunities for moral education2019In: Journal of Moral Education, ISSN 0305-7240, E-ISSN 1465-3877, Vol. 48, no 2, p. 199-213Article in journal (Refereed)
    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.

    Download full text (pdf)
    fulltext
  • 5.
    Brüggemann, Adrianus Jelmer
    et al.
    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.
    Persson, Alma
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Clinical and Experimental Medicine.
    Using forum play to prevent abuse in health care organizations: A qualitative study exploring potentials and limitations for learning2016In: Education for Health, ISSN 1357-6283, E-ISSN 1469-5804, Vol. 29, no 3, p. 217-222Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Abuse in health care organizations is a pressing issue for caregivers. Forum play, a participatory theater model, has been used among health care staff to learn about and work against abuse. This small-scale qualitative study aims to explore how forum play participants experience the potentials and limitations of forum play as an educational model for continued professional learning at a hospital clinic.

    METHODS:

    Fifteen of 41 members of staff of a Swedish nephrology clinic, primarily nurses, voluntarily participated in either one or two forum play workshops, where they shared experiences and together practiced working against abuse in everyday health care situations. Interviews were conducted after the workshops with 14 of the participants, where they were asked to reflect on their own and others' participation or nonparticipation, and changes in their individual and collective understanding of abuse in health care.

    RESULTS:

    Before the workshops, the informants were either hesitant or very enthusiastic toward the drama-oriented form of learning. Afterward, they all agreed that forum play was a very effective way of individual as well as collective learning about abuse in health care. However, they saw little effect on their work at the clinic, primarily understood as a consequence of the fact that many of their colleagues did not take part in the workshops.

    DISCUSSION:

    This study, based on the analysis of forum play efforts at a single hospital clinic, suggests that forum play can be an innovative educational model that creates a space for reflection and learning in health care practices. It might be especially fruitful when a sensitive topic, such as abuse in health care, is the target of change. However, for the effects to reach beyond individual insights and a shared understanding among a small group of participants, strategies to include all members of staff need to be explored.

    Download full text (pdf)
    fulltext
  • 6.
    Brüggemann, Adrianus Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Abuse in health care: a concept analysis2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, p. 123-132Article in journal (Refereed)
    Abstract [en]

    Aims and objectives:  To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is different from the related concepts of medical error, patient satisfaction and personal identity threat.

    Background:  Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated.

    Design:  Concept analysis as developed by Walker and Avant.

    Method:  The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care, four on medical error, six on patient satisfaction and three on personal identity threat.

    Results:  Abuse in health care is defined by patients’ subjective experiences of encounters with the health care system, characterized by devoid of care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. We also found differences with the aforementioned related concepts: medical error does not share the patients’ perspective, and patient satisfaction does not offer room for patients’ abusive experiences. The concept of personal identity threat shares all attributes with abuse in health care, but it lacks an antecedent that signifies the social structures underlying the phenomenon.

    Conclusions:  Abuse in health care covers a phenomenon that has severe consequences but is invisible if seen from a medical error or patient satisfaction perspective.

    Download full text (pdf)
    fulltext
  • 7.
    Brüggemann, Jelmer
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Ett potentiellt problem: Om maskulinitet och behandling för prostatacancer2018In: Prostatan – det ständiga gisslet?: mannen och prostatan i kultur, medicin och historia / [ed] Maria Björkman, Lund: Nordic Academic Press, 2018, p. 89-103Chapter in book (Other academic)
  • 8.
    Brüggemann, Jelmer
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Exploring patient strategies in response to untoward healthcare encounters2017In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 2, p. 190-197Article in journal (Refereed)
    Abstract [en]

    Background: Increasing attention to patients’ rights and their ability to choose their healthcare provider have changed the way patients can respond to untoward, disempowering and abusive healthcare encounters. These responses are often seen as crucial for quality improvement, yet they are little explored and conceptualized.

    Objective: To explore patients’ potential responses to untoward healthcare encounters and looking at their possible consequences for care quality improvement as well as for the individual patient.

    Research design: The article is structured looking at two primary strategies: patient exit (leaving a healthcare provider) and patient voice (expressing grievances), derived from Hirschman (1970). These strategies were explored by the use of theoretical and empirical literature and applied to an individual patient case. The case functions as a pedagogical tool to illustrate and problematize what exit and voice strategies can mean for a single patient.

    Ethical considerations: The patient case is my version of a generalized scenario that is described elsewhere. It does not represent an individual patient’s story, but aims to be realistic and recognizable.

    Findings and conclusion: Based on the existing literature, it is hypothesized that, in their current form, exit and voice strategies have a limited effect on care quality and can come at a price for patients. However, both strategies may be of value to patients and providers. Therefore, the healthcare system could empower patients to engage in action and could further develop ways for providers to effectively use patients’ responses to improve practice and find ways to prevent patients from untoward experiences in healthcare.

    Download full text (pdf)
    fulltext
  • 9.
    Brüggemann, Jelmer
    et al.
    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, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Forsberg, Camilla
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Thornberg, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Re-negotiating agency: patients using comics to reflect upon acting in situations of abuse in health care2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 58Article in journal (Refereed)
    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.

    Download full text (pdf)
    Re-negotiating agency – patients using comics to reflect upon acting in situations of abuse in health care
  • 10.
    Brüggemann, Jelmer
    et al.
    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, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Persson, Alma
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Understanding and preventing situations of abuse in health care: Navigation work in a Swedish palliative care setting2019In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 222, p. 52-58Article in journal (Refereed)
    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.

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  • 11.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Anmälningsplikt för kränkningar bör inkluderas i lex Maria2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 5, p. 217-217Article in journal (Other (popular science, discussion, etc.))
  • 12.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Department of Health and Caring Sciences, Linnaeus University, Sweden.
    Staff silence about abuse in health care: An exploratory study at a Swedish women’s clinic2014In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 9, p. 71-76Article in journal (Refereed)
    Abstract [en]

    It has been well documented that patients can feel abused in health care and that many patients suffer from these experiences. Insight lacks into contributing factors behind such events. Silence surrounding the abuse has been suggested as a possible mechanism. The present study explores silence surrounding the abuse as a possible contributing factor. We have explored whether this silence is connected with the staff’s hierarchical position and with the staff’s own experiences as patients abused in health care.

    Methods During January 2008, a paper questionnaire was sent to all staff members at a Swedish women’s clinic. The questionnaire included questions on sociodemography and profession and multiple questions about abuse in health care. After univariate testing, a binary logistic regression model including variables concerning profession and staff’s own experiences of abuse was built.

    Results Our data show that in contrast to midwives and gynaecologists, auxiliary nurses seldom report hearing about cases of abuse in health care. Staff who themselves experienced abuse in health care as patients, so-called wounded healers, were more likely to have heard about abuse in health care during the last 12 months.

    Conclusions This study suggests that a form of silence reigns over events of abuse in health care that is not randomly distributed over staff. Professional hierarchies and staff’s own experiences of abuse as patients could be considered in the design of interventions to break the silence surrounding patients’ experiences of abuse in health care.

  • 13.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus University, Sweden.
    Wijma, Barbro
    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.
    A first online intervention to increase patients perceived ability to act in situations of abuse in health care: reports of a Swedish pre-post study2015In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, no 35Article in journal (Refereed)
    Abstract [en]

    Background: Efforts to counteract abuse in health care, defined as patient-experienced abuse, have mainly focused on interventions among caregivers. This study is the first to test an online intervention focusing on how patients can counteract such abuse. The intervention aimed at increasing patients intention and perceived ability to act in future situations where they risk experiencing abuse. Methods: Participants were recruited through a nephrology clinic in Sweden. The intervention consisted of an online program that aimed to stimulate patients to think of possible actions in situations in which they risk experiencing abuse. The program comprised stories and exercises in text and comic form. The participants filled out a questionnaire immediately before and after going through the program, as well as during follow-up four to eight weeks later. Results: Forty-eight patients (39 %) participated in the study and spent, on average, 41 min responding to questions and going through the program. Both men and women, of various ages and educational backgrounds, participated. An increase in participants self-reported ability to identify opportunities to act in a given situation was seen immediately afterwards, as well as during follow up. Conclusion: The current study suggests that it is feasible and most likely useful to a variety of patients to work with the provided material that has the aim of counteracting abuse in health care. It would be of interest to further develop ways of using comics and to test similar interventions in other health care settings.

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  • 14.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Patients’ silence following healthcare staff’s ethical transgressions2012In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 19, no 6, p. 750-763Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine to what extent patients remained silent to the health care system after they experienced abusive or wrongful incidents in health care. Female patients visiting a women’s clinic in Sweden (n = 530) answered the Transgressions of Ethical Principles in Health Care Questionnaire (TEP), which was constructed to measure patients’ abusive experiences in the form of staff’s transgressions of ethical principles in health care. Of all the patients, 63.6% had, at some point, experienced staff’s transgressions of ethical principles, and many perceived these events as abusive and wrongful. Of these patients, 70.3% had remained silent to the health care system about at least one transgression. This silence is a loss of essential feedback for the health care system and should not automatically be interpreted as though patients are satisfied.

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  • 15.
    Danemalm Jägervall, Carina
    et al.
    Växjö county hospital, Växjö, Sweden.
    Brüggemann, Jelmer
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Johnson, Ericka
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences.
    Gay men’s experiences of sexual changes after prostate cancer treatment: a qualitative study in Sweden2019In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, no 1, p. 40-44Article in journal (Refereed)
    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.

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  • 16.
    Danemalm Jägervall, Carina
    et al.
    Kirurgkliniken, Centrallasarettet Växjö, Växjö, Sweden.
    Gunnarsson, Birgitta
    FoU Kronoberg, Region Kronoberg; Institutionen för neurovetenskap och fysiologi, Göteborgs universitet.
    Brüggemann, Jelmer
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Orgasmen förändras negativt men uteblivet ejakulat ingen stor förlust [Patients’ experiences of orgasm changes and loss of ejaculation after radical prostatectomy]: Tio män om orgasmupplevelse och ejakulationsbortfall efter radikal prostatektomi2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, no 3, p. 1470-1472Article in journal (Refereed)
    Abstract [en]

    Patients' experiences of orgasm changes and loss of ejaculation after radical prostatectomy   In this study we report on men's experiences of orgasm changes and loss of ejaculation after radical prostatectomy. Ten men, all recruited through a Swedish hospital, were interviewed and data was analyzed using qualitative content analysis. The results showed that the experience of orgasm has weakened but that the loss of ejaculation was not perceived as a loss per se. However, the risk of urine release during orgasm was troublesome and inhibiting. These challenges were framed within an existential narrative about sexuality, as expressed in preoperative sexual farewell rituals and postoperative feelings of ambivalence and regret. These findings can be used in the design of patient information and for sexual rehabilitation treatment.

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    Orgasmen förändras negativt men uteblivet ejakulat ingen stor förlust [Patients’ experiences of orgasm changes and loss of ejaculation after radical prostatectomy]: Tio män om orgasmupplevelse och ejakulationsbortfall efter radikal prostatektomi
  • 17.
    Simmons, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Brüggemann, Adrianus Jelmer
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden .
    Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, article id e010847Article in journal (Refereed)
    Abstract [en]

    Despite associations between being subjected to violence and ill-health being well known, most victims have never told health care professionals about their victimisation. Although both experiences of victimisation and help-seeking behaviour are gendered, male victims’ encounters with the health care system are under-researched. The aim of this study was to develop a theoretical model concerning male victims’ processes of disclosing experiences of being subjected to violence to health care professionals in Sweden. Constructivist grounded theory was used. Twelve men who had reported experiences of emotional, sexual, and/or physical violence by any type of perpetrator in an earlier quantitative study were interviewed. Conflicting thoughts within the men affected their likelihood of disclosing their victimisation. For example, a sense of urgency to seek help increased their likelihood, whereas shame and fear of negative consequences decreased their likelihood. Conformity to hegemonic masculinity had a strong negative influence, and was tipping the men towards a low likelihood of disclosing victimisation. Health care professionals strongly influence the disclosing process. For example, a good patient-provider relationship would help the men disclose, whereas a strong factor hindering disclosure was professionals’ adherence to gender norms, thus neither validating men’s experiences of violence nor acknowledging their psychological suffering.

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  • 18.
    Wijma, Barbro
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Persson, Alma
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences.
    Ockander, Marlene
    Jönköping Academy for Improvement of Health and Welfare, Jönköping University.
    Brüggemann, Jelmer
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Kränkningar i vården är vanligt förekommande [Abuse in healthcare – Lessons learned during two decades of research]: Viktigt med aktivt arbete mot att patienter kränks2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, p. 1-6Article, review/survey (Other academic)
    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.

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    Kränkningar i vården är vanligt förekommande: Viktigt med aktivt arbete mot att patienter kränks
  • 19.
    Wijma, Barbro
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Persson, Alma
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences.
    Ockander, Marlene
    The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Sweden.
    Brüggemann, Jelmer
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Upprepad utsatthet - bakgrund av övergrepp hos kvinnor och män och risken att uppleva kränkningar i vården2019In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 96, no 4, p. 499-518Article in journal (Refereed)
    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.

  • 20.
    Wijma, Barbro
    et al.
    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.
    Zbikowski, Anke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Ryhov County Hospital, Sweden.
    Brüggemann, Jelmer
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Silence, shame and abuse in health care: theoretical development on basis of an intervention project among staff2016In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, no 75Article in journal (Refereed)
    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.

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  • 21.
    Zbikowski, Ancke
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Brüggemann, Adrianus Jelmer
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Zeiler, Kristin
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Ethical guidelines and the prevention of abuse in healthcare2012In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 165, no 1, p. 18-28Article, review/survey (Refereed)
    Abstract [en]

    Objective

    In obstetrical and gynaecological healthcare, patients often find themselves in a vulnerable position. Sensitive issues such as sexual and reproductive health are addressed and certain procedures can be experienced as abusive. According to research a lifetime prevalence of abuse in healthcare (AHC) can be assumed for 13–28% of female patients in the Nordic countries. In the present study we analyse the content of ethical documents for healthcare professionals within obstetrics and gynaecology in Sweden, in order to find out to what extent ethicalguidelines consider issues that have shown to be related to the occurrence of AHC.

    Study design

    We searched the literature to find empirical data on AHC. Guidelines for nurses, midwives and physicians were selected. After developing an analytical framework based on the empirical data the content of the ethicalguidelines was analysed.

    Results

    The various ethicalguidelines for staff working within obstetrics and gynaecology differ distinctively from each other regarding their content of issues that are related to AHC. Issues that were mostly disregarded were: considering the patient's perspective and the patients’ possible experience of violence, considering power imbalances within healthcare, sexual misconduct, how to deal with other professional's ethical misconduct and how professionals relate to each other. We found the ethicalguidelines of the International Federation of Gynecology and Obstetrics (FIGO) and of the International Confederation of Midwives to be those which contained most of the issues that have empirically shown to be important in regard to AHC.

    Conclusion

    While staff members from different professions may share responsibility for the same patient, their ethicalguidelines vary considerably. To become a possible resource for prevention of AHC, we suggest that ethicalguidelines in healthcare should be revised following empirical research on ethical conduct. As ethicalguidelines cannot be effective by their existence only, we would like to initiate a discussion on the function and use of ethicalguidelines in general and regarding AHC in particular. Being aware that ethicalguidelines are only a part of ethics in healthcare, however, we envision a broader approach to the aim of preventing AHC, where research is encouraged on how a virtue ethics approach could be applied.

  • 22.
    Zbikowski, Anke
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Brüggemann, A. Jelmer
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    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.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Counteracting Abuse in Health Care: A Quantitative Evaluation of an Intervention with Forum Play for Staff2014Manuscript (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.

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