| 1. |
- Brüggemann, Adrianus Jelmer, 1981-, et al.
(författare)
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Abuse in health care : a concept analysis
- 2012
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 26:1, s. 123-132
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 2. |
- Brüggemann, Adrianus Jelmer, 1981-, et al.
(författare)
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Bystander passivity in health care and school settings : Moral disengagement, moral distress, and opportunities for moral education
- 2019
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Ingår i: Journal of Moral Education. - : Routledge. - 0305-7240 .- 1465-3877. ; 48:2, s. 199-213
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 3. |
- Brüggemann, A. Jelmer, et al.
(författare)
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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
- 2012
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 2:6
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 4. |
- Brüggemann, A. Jelmer
(författare)
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Toward an Understanding of Abuse in Health Care : A Female Patient Perspective
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.
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| 5. |
- Brüggemann, Adrianus Jelmer, 1981-, et al.
(författare)
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Using forum play to prevent abuse in health care organizations: A qualitative study exploring potentials and limitations for learning
- 2016
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Ingår i: Education for Health. - : Wolters Kluwer. - 1357-6283 .- 1469-5804. ; 29:3, s. 217-222
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 6. |
- Brüggemann, A. Jelmer, et al.
(författare)
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What contributes to abuse in health care? : A grounded theory of female patients’ stories
- 2013
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 50:3, s. 404-412
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn 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.ObjectivesTo understand what factors contribute to female patients’ experiences of abuse in health care.DesignConstructivist grounded theory approach.SettingsWomen's clinic at a county hospital in the south of Sweden.ParticipantsTwelve female patients who all had reported experiences of abuse in health care in an earlier questionnaire study.MethodsIn-depth interviews.ResultsThe 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.ConclusionsCentral 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.
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| 7. |
- Brüggemann, Jelmer, et al.
(författare)
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A first online intervention to increase patients’ perceived ability to act in situations of abuse in health care : reports of a Swedish pre-post study
- 2015
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Ingår i: BMC Medical Ethics. - : Springer Science and Business Media LLC. - 1472-6939 .- 1472-6939. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEfforts 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.MethodsParticipants 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.ResultsForty-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.ConclusionThe 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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| 8. |
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| 9. |
- Brüggemann, Jelmer, et al.
(författare)
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Anmälningsplikt för kränkningar bör inkluderas i lex Maria
- 2011
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 108:5, s. 217-217
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Lex Maria bör bygga på samma filosofi som lex Sarah, och det systemtänkande som lex Maria är född ur bör gälla för kränkningar lika väl som för rent medicinska misstag.
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