Counteracting Abuse in Health Care from a Staff Perspective : Ethical Aspects and Practical Implications

Abstract

To Marianne Zbikowski Abstract Background: Abuse of patients by health care staff (AHC) is a cause of unnecessary suffering, which is inconsonant with the premise in medicine of not doing harm to the patient. The understanding of AHC in this thesis is considered two-dimensional: as a patient's subjective experience and as violation of a patient's dignity. Patients' experiences of these events are rather well studied and are characterized by feelings of neglect and a loss of their human value. However, little is known about staff's perspectives on AHC and what they can do to counteract it.

Understanding and preventing situations of abuse in health care – Navigation work in a Swedish palliative care setting

“…At a women's clinic, the intimate examinations that render patients vulnerable are considered to be a particular challenge, while staff at a nephrology clinic stress the fact that they work with patients who need care several times a week, most likely for the rest of their lives. This poses particular challenges to the ways in which they interact with patients (see also Brüggemann & Persson, 2016;Wijma et al, 2016;Zbikowski, 2014). In the same way, what is considered abusive also varies between health care systems, and changes over time (d'Oliveira et al, 2002;Jewkes et al, 1998).…”

“…Previous work in the area (Brüggemann & Persson, 2016;Wijma, Zbikowski, & Brüggemann, 2016;Zbikowski, 2014) has been organized as traditional intervention studies, while the current project built on interactive research (Svensson, Ellström, & Brulin, 2007). This approach has been developed in the Nordic region and is related to action research, with researchers directly intervening in practices and engaging in change activities (Svensson et al, 2007).…”

“…Following this position, in our interactions with professionals at the clinic, we did not pinpoint what counts as abusive treatment or not, but adopted an open, practiceoriented approach. We described abuse in health care (kränkningar in Swedish) as situations that staff identify as abusive to their patients (in line with Zbikowski, 2014), further contextualized by giving examples and themes from earlier patient interview studies (Brüggemann & Swahnberg, 2013;Swahnberg et al, 2007;Swahnberg et al, 2009).…”

Exploring patient strategies in response to untoward healthcare encounters

“…24, p. 760 This emphasizes the need of not only empowering patients to use voice and exit strategies, but, e.g., also to educate staff to counteract abuse in health care. 42 In order to understand patients' behaviour and the implications of voice and exit strategies, patients' power in relation to their caregiver should be considered.…”

Toward an integrated approach in research on interpersonal violence : Conceptual and methodological challenges

“…That is not because I do not find it important, but it was not my main focus of interest. Two other recent theses as well as a series of scientific papers have explored the topic of abuse in health care (Brüggemann, 2012;Zbikowski, 2014). Hence, in this thesis I offer only glimpses of the integrated approach I call upon, but these glimpses all underline the need for more integrative perspectives in research on interpersonal violence.…”