| 1. |
- 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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| 2. |
- 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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| 3. |
- 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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| 4. |
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| 5. |
- Brüggemann, Jelmer
(författare)
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Exploring patient strategies in response to untoward healthcare encounters
- 2017
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 24:2, s. 190-197
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 6. |
- Brüggemann, Jelmer, 1981-, et al.
(författare)
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Re-negotiating agency : patients using comics to reflect upon acting in situations of abuse in health care
- 2019
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere 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.MethodsQualitative 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.ResultsIt 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.ConclusionThe 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.
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| 7. |
- Brüggemann, Jelmer, 1981-, et al.
(författare)
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Understanding and preventing situations of abuse in health care : Navigation work in a Swedish palliative care setting
- 2019
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 222, s. 52-58
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Tidskriftsartikel (refereegranskat)abstract
- 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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| 8. |
- Danemalm Jägervall, Carina, et al.
(författare)
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Gay men’s experiences of sexual changes after prostate cancer treatment : a qualitative study in Sweden
- 2019
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Ingår i: Scandinavian journal of urology. - : Taylor & Francis. - 2168-1805 .- 2168-1813. ; 53:1, s. 40-44
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Tidskriftsartikel (refereegranskat)abstract
- 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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| 9. |
- Danemalm Jägervall, Carina, et al.
(författare)
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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
- 2016
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 113:3, s. 1470-1472
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Tidskriftsartikel (refereegranskat)abstract
- 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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| 10. |
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Människan i medicinen : En utställning om medicinsk humaniora
- 2019
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Konstnärligt arbeteabstract
- Vad händer med människors bild av sig själva och sin kropp när de blir del av en medicinsk verksamhet? Hur ändras synen på människan genom medicinsk utveckling? Och vilka föreställningar om människor styr vården och dess organisation?Medicinsk humaniora och samhällsvetenskap är ett tvärvetenskapligt forskningsfält som studerar komplexa relationer mellan hälsa, sjukdom, medicinsk utveckling och kultur. Ämnet kan förse kliniskt verksamma och studenter inom medicin- och vårdutbildningar med nya perspektiv på centrala frågor kring människors hälsa eller vårdens vardag – frågor som inte alltid får utrymme i en tid där vården tvingas till effektivisering och medicinsk utveckling sker i allt snabbare takt.Människan i medicinen lyfter fram några aktuella forskningsprojekt vid Linköpings universitet, avslutade såväl som nystartade.
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