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

Abstract

ObjectiveThe study aim was to apprehend staff's perception of abuse in healthcare (AHC) after an intervention based on ‘Forum Play’, and make comparisons to preintervention interviews and interviews with male and female patients. AHC can be described as a failing encounter from the patient's perspective.DesignQualitative interview follow-up study.SettingA Swedish Women's Clinic.ParticipantsIn a preintervention study 21 staff members were interviewed. Eligible for the follow-up study were 14 informants who had participated in the intervention. Four declined participation leaving ten informants for this study.InterventionDuring January 2008–January 2009, all staff members (N=136) were invited to participate in Forum Play workshops. Seventy-four participants took part in at least 1 of the 17 half-day workshops.Primary outcome measuresStaffs perception of AHC.ResultsThe core category, ‘a summoning stone in the shoe’, was constructed of five categories: ‘Dehumanising the patient’, ‘Unacceptable: you are bound to act!’, ‘Ubiquitous’, ‘Unintentional’ and ‘Relative’. Forum Play had demonstrated possibilities to act even in seemingly ‘impossible’ situations, and that the taboo status of AHC was altered at the clinic. When our results were compared to those in the preintervention study, we found an increased awareness about AHC, more concrete examples of AHC, a stronger empathy for patients, and fewer explanations, justifications and trivialisations of AHC.ConclusionIn this follow-up study staff's perception of AHC was closer to the patient's perspective. Compared to the preintervention interviews staff showed a greater willingness not only to acknowledge AHC, but also to take on a responsibility to act in order to stop or prevent AHC. Explanations for this stance could be that Forum Play had showed staff that there were possibilities to act, and that the taboo status of AHC had been broken at the clinic.

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

“…Additionally, the participants in FP workshops reported having experienced more situations involving moral dilemmas when they acted more according to their own moral beliefs. The picture suggested by the results of study IV, namely, that FP facilitates a shift towards a patient perspective, is supported by Swahnberg and Wijma's study, which was based on interviews with staff from the target clinic before and after a workshop series (120). It showed that FP participants expressed an increased awareness of AHC and a greater willingness to acknowledge AHC and to take on responsibility to act in order to stop AHC.…”

A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour

“…Swahnberg and Wijma [46] used an intervention based on "forum play" (see Additional file 4: Table S5) to understand staffs perceptions of Abuse in Health Care (AHC). Findings were particularly relevant to psychological safety as the intervention created an open climate where all staff felt comfortable discussing AHC.…”

“…One further study [36] found no significant relationship. Three studies [39,46,47] reported improved and one study [48] found mixed results for "communication and collaboration" following interventions. Five studies [38,40,42,44,45] reported positive evaluations by participants postinterventions.…”

Notification of an abnormal Pap smear result: An intervention study

“…Thereafter, ten of the healthcare providers, led by a drama teacher, participated in a one‐day training with forum play (Boal & Jackson, ), focusing on empathetic communication. Forum play has previously been used with good results (Swahnberg & Wijma, ; Zbikowski, Bruggemann, Wijma, Zeiler, & Swahnberg, ). Furthermore, healthcare providers were designated to notify women of their abnormal Pap smear results orally by phone, and schedule an appointment with the physician.…”