Ethical lapses: staff's perception of abuse in health care

Abstract

Objective. Studies have shown high lifetime prevalence of abuse in health care (AHC) in Nordic gynaecological patients. For patients AHC implies feeling disempowered, dehumanised and devalued. The aim of our study was to apprehend health care staff's perceptions of AHC. Study design. Qualitative interviews with staff at a Swedish gynaecological clinic analysed by Constant comparative analysis (N = 21). Results. The two categories - ethical failures against a patient and staff members avoid responsibility - gives two disparate pictures of what AHC is. The interviews showed that these pictures can exist alongside even if they contradict each other. The core category 'ethical lapses' brings staff's contradictory reflections on AHC together in one picture. Notable is that the dualistic notion of AHC did not result in a moral conflict within staff members. Conclusion. Health care staff perceives AHC primarily as ethical lapses. Avoiding responsibility for AHC might lead to a failing recognition of AHC, implying that the problem is not properly dealt with. Our study highlights the need for a more open attitude in health care staff toward AHC. To counteract AHC, staff members need to accept that AHC occurs also in their own units, bringing in moral conflicts in the everyday work.

Staff's perception of abuse in healthcare: a Swedish qualitative study

“…in the present study, are closer to the experiences of both female and male patients than those of the study that posed the same question to staff prior to the intervention, where the core category was 'ethical lapses'. [15][16][17] Apparently, staff's perception of AHC were closer to the patient's perspective.…”

“…17 18 They recognised AHC as 'transgressions of ethical principles' but stated that these actions were often justifiable from a staff perspective for various reasons. 17 Staff's awareness of AHC also turned out to be a complex phenomenon restricted by their possibilities to act, for example, caused by hierarchies or because they did not know what to do since they had no tools or training in handling AHC. 18 The strongest expressions of change in the present study, when compared to the preintervention studies, was the increased awareness about AHC, stronger empathy for patients displayed in more concrete examples of, and fewer explanations, justifications and trivialisations of AHC.…”

“…In accordance with their ambiguity and inability to handle AHC, it was treated with silence and as a taboo. 17 Moreover, staff's awareness of AHC was dependent on their possibilities to act; low awareness was seen when there were few possibilities to act. 18 High prevalence of AHC, creating long-lasting suffering among patients and little awareness about the problem among staff forced us to design and test an intervention against AHC.…”

Minimizing human dignity: staff perception of abuse in health care

“…12,13 However, there are different ethical standards that ensure that patients are treated well in health care. Among the many methods that health-care educators have used to teach ethics, we can only mention a few here.…”

Staff's awareness of abuse in health care varies according to context and possibilities to act

“…In interview studies patients recognized AHC as a frequent and serious problem (8,(16)(17)(18), while staff generally had difficulties to remember any concrete episodes of AHC, even though they believed that AHC occurred frequently even at their clinic (19). Our research question was based on this paradox; to what extent is staff aware of AHC?…”