| 1. |
- Bayram, Gökçe, et al.
(författare)
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Health care professionals’ view on pedophilic disorder : a qualitative study
- 2021
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Ingår i: Sexual and Relationship Therapy. - : Taylor & Francis Group. - 1468-1994 .- 1468-1749. ; 38:4, s. 684-695
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Tidskriftsartikel (refereegranskat)abstract
- In the last few years there has been a shift in the view on pedophilia and its treatment in international diagnostic manuals and expert consensus documents. This study seeks to investigate the approach of health care professionals’ on some of the topics that are mostly debated: whether pedophilia without distress or acting out should be considered a mental disorder, whether there can be a changeability of pedophilic sexual interest over life and what the main aim of treatment should be. Qualitative content analysis was used to analyze the responses in semi-structured interviews of eight Swedish health care professionals with significant clinical experience from this patient category. These results suggest that there is a lack of consensus regarding all three topics, and that the opinions of the experienced health care professionals did not fully comply with the international experts agreements. This might lead to differences in clinical practice depending on who meets the patient, it can make the patients unsure about how they will be treated if they seek help, and it demonstrates a gap between published international research and clinical practice.
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| 2. |
- Godskesen, Tove, et al.
(författare)
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Challenges regarding informed consent in recruitment to clinical research : a qualitative study of clinical research nurses' experiences
- 2023
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Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clinical research nurses (CRNs) have first-hand experience with ethical challenges and play a crucial role in upholding ethical conduct and adherence to the principles of informed consent in clinical research. This study explores the ethical challenges encountered by CRNs in the process of obtaining informed consent for clinical research.Methods: A qualitative exploratory design. Semistructured interviews (n = 14) were conducted with diverse CRNs in Sweden. These CRNs covered a wide range of research fields, including pharmaceutical and academic studies, interventions, and observational research, spanning different trial phases, patient categories, and medical conditions. The interviews were analysed using inductive qualitative content analysis.Results:The analysis identified three main categories: (i) threats to voluntariness, (ii) measures to safeguard voluntariness, and (iii) questionable exclusion of certain groups. CRNs face challenges due to time constraints, rushed decisions, information overload, and excessive reliance on physicians' recommendations. Overestimating therapeutic benefits in stages of advanced illness emerged as a risk to voluntariness. CRNs outlined proactive solutions, such as allowing ample decision-making time and offering support, especially for terminally ill patients. Concerns were also voiced about excluding certain demographics, such as those with language barriers or cognitive impairments.Conclusions: In conclusion, upholding ethical research standards requires recognising various factors affecting patient voluntariness. Researchers and CRNs should prioritise refining the informed consent process, overcoming participation challenges, and aligning scientific rigour with personalised care. Additionally, a concerted effort is vital to meet the diverse needs of patient populations, including equitable inclusion of individuals with language barriers or cognitive limitations in clinical studies. These findings have significant implications for enhancing the ethics of clinical research and advancing person-centred care.
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| 3. |
- Guenna Holmgren, Amina, et al.
(författare)
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Restraint in somatic healthcare : how should it be regulated?
- 2023
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Ingår i: Journal of Medical Ethics. - : BMJ Publishing Group Ltd. - 0306-6800 .- 1473-4257.
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Tidskriftsartikel (refereegranskat)abstract
- Restraint is regularly used in somatic healthcare settings, and countries have chosen different paths to regulate restraint in somatic healthcare. One overarching problem when regulating restraint is to ensure that patients with reduced decision-making capacity receive the care they need and at the same time ensure that patients with a sufficient degree of decision-making capacity are not forced into care that they do not want. Here, arguments of justice, trust in the healthcare system, minimising harm and respecting autonomy are contrasted with different national regulations. We conclude that a regulation that incorporates an assessment of patients’ decision-making capacity and considers the patient’s best interests is preferable, in contrast to regulations based on psychiatric diagnoses or regulations where there are no legal possibilities to exercise restraint at all in somatic care.
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| 4. |
- Guenna Holmgren, Amina, et al.
(författare)
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Understanding nurses’ justification of restraint in a neurosurgical setting : A qualitative interview study
- 2022
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 30:1, s. 71-85
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Tidskriftsartikel (refereegranskat)abstract
- Background Despite its negative impact on patients and nurses, the use of restraint in somatic health care continues in many settings. Understanding the reasons and justifications for the use of restraint among nurses is crucial in order to manage this challenge.Aim To understand nurses’ justifications for restraint use in neurosurgical care.Research design A qualitative, descriptive design was used. Data were analysed with inductive qualitative content analysis.Participants and research context Semi-structured interviews with 15 nurses working in three neurosurgical departments in Sweden.Ethical considerations Approved by The Regional Ethics Committee, Stockholm, Sweden.Findings The analysis resulted in three categories. The category Patient factors influencing restraint use describes patient factors that trigger restraint, such as a diminished decision-making competence, restlessness, and need for invasive devices. The category Specific reasons for justifying restraint describes reasons for restraining patients, such as restraint being used for the sake of the patient or for the sake of others. The category General reasoning in justifying restraint describes how nurses reason when using restraint, and the decision to use restraint was often based on a consequentialist approach where the nurses’ weighed the pros and cons of different alternatives.Discussion Nurses with experience of restraint use were engaged in a constant process of justifying and balancing different options and actions. Restraint was considered legitimate if the benefit exceeded the suffering, but decisions on which restraint measures to use and when to use them depended on the values of the individual nurse.Conclusion How nurses reason when justifying restraint, why they use restraint, and who they use restraint on must be considered when creating programs and guidelines to reduce the use of restraint and to ensure that when it is used it is used carefully, appropriately, and with respect.
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| 5. |
- Gustavsson, Erik, et al.
(författare)
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Should relational effects be considered in health care priority setting?
- 2023
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Ingår i: Bioethics. - : John Wiley & Sons. - 0269-9702 .- 1467-8519. ; 37:7, s. 668-673
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Tidskriftsartikel (refereegranskat)abstract
- It is uncontroversial to claim that the extent to which health care interventions benefit patients is a relevant consideration for health care priority setting. However, when effects accrue to the individual patient, effects of a more indirect kind may accrue to other individuals as well, such as the patient's children, friends, or partner. If, and if so how, such relational effects should be considered relevant in priority setting is contentious. In this paper, we illustrate this question by using disease-modifying drugs for Alzheimer's disease as a case in point. The ethical analysis begins by sketching the so-called prima facie case for ascribing moral weight to relational effects and then moves on to consider a number of objections to it. We argue that, whereas one set of objections may be dismissed, there is another set of arguments that poses more serious challenges for including relational effects in priority setting.
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| 6. |
- Gustavsson, Martina E., et al.
(författare)
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"Being prevented from providing good care : a conceptual analysis of moral stress among health care workers during the COVID-19 pandemic"
- 2023
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Ingår i: BMC Medical Ethics. - Stockholm : BioMed Central (BMC). - 1472-6939 .- 1472-6939. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundHealth care workers (HCWs) are susceptible to moral stress and distress when they are faced with morally challenging situations where it is difficult to act in line with their moral standards. In times of crisis, such as disasters and pandemics, morally challenging situations are more frequent, due to the increased imbalance between patient needs and resources. However, the concepts of moral stress and distress vary and there is unclarity regarding the definitions used in the literature. This study aims to map and analyze the descriptions used by HCWs regarding morally challenging situations (moral stress) and refine a definition through conceptual analysis.MethodsQualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis.ResultsThree themes emerged from the content analysis (1) "Seeing, but being prevented to act; feeling insufficient/inadequate and constrained in the profession," (2) "Someone or something hindered me; organizational structures as an obstacle," and (3) "The pandemic hindered us; pandemic-related obstacles." The three themes correspond to the main theme, "Being prevented from providing good care."DiscussionThe main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions.ConclusionsOn the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon.
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| 9. |
- Lundahl, Antoinette, et al.
(författare)
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Is compulsory care ethically justified for patients with borderline personality disorder?
- 2023
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Ingår i: Clinical Ethics. - : Sage Publications. - 1477-7509 .- 1758-101X.
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Tidskriftsartikel (refereegranskat)abstract
- Patients with borderline personality disorder (BPD) are overrepresented in compulsory inpatient care for suicide-protective reasons. Still, much evidence indicates negative effects of such care, including increased suicide risk. Clinical guidelines are contradictory, leaving clinicians with difficult ethical dilemmas when deciding on compulsory care. In this study, we analyse the arguments most commonly used in favour of compulsory care of BPD patients, to find out in what situations such care is ethically justified. The aim is to guide clinicians when deciding on compulsory care for BPD patients and reduce the use of potentially harmful care. The arguments analysed are (a) the patients lack decision competence, (b) the patients lack authenticity, (c) compulsory care saves the patient from suicide, (d) compulsory care safeguards against litigation, complaints, or doctor's anxiety, (e) compulsory care is a practical solution in emergencies, and (f) it is better for the caregiver to ‘err on the safe side’. We conclude that compulsory care is not ethically justified in most cases unless the clinician has probable reason to believe that the patient lacks decision capacity by suffering from a severe mental co-morbidity and stands to benefit from such care.
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| 10. |
- Lundahl, Antoinette, et al.
(författare)
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Patients with borderline personality disorder and the effects of compulsory admissions on self-harm behaviour : a questionnaire study
- 2023
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 77:5, s. 498-505
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious research on patients with borderline personality disorder (BPD) has indicated negative effects, including increased suicidality, from long hospital admissions and paternalism. Still, long-term compulsory admissions have been reported to occur regularly. Less is known about how healthcare personnel perceives these admissions and to what extent they think the use of compulsory care can be diminished. This study addresses those questions to make care more beneficial.MethodsA questionnaire study, the respondents being nurses and psychiatric aides employed at psychiatric hospital wards in Sweden. The questionnaire contained questions with fixed answers and room for comments. 422 questionnaires were distributed to 21 wards across Sweden, and the response rate was 66%. The data were analysed with descriptive statistics and qualitative descriptive content analysis.ResultsMost respondents experienced that more than a week’s compulsory admission either increased (68%) or had no effect (26%) on self-harm behaviour. A majority (69%) considered the compulsory admissions to be too long at their wards, with detrimental effects on the patients. They also recognized several reasons for compulsory admissions without medical indication, like doctors’ fear of complaints and patients’ lack of housing. Also, patients sometimes demand compulsory care. Respondents recommended goal-oriented care planning, around three-day-long voluntary admissions, and better outpatient care to reduce compulsory hospital admissions.DiscussionThese findings imply that many BPD patients are regularly forced to receive psychiatric care that inadvertently can make them self-harm more. The respondents’ comments can be used as a source when formulating clinical guidelines.
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