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  • 1.
    Brüggemann, Jelmer
    et al.
    Linköping University.
    Swahnberg, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Hälsouniversitetet, Linköping.
    Staff silence about abuse in health care: an exploratory study at a Swedish women’s clinic2014In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 9, no 2-3, p. 71-76Article in journal (Refereed)
    Abstract [en]

    Background It has been well documented that patients can feel abused in health care and that many patients suffer from these experiences. Insight lacks into contributing factors behind such events. Silence surrounding the abuse has been suggested as a possible mechanism. The present study explores silence surrounding the abuse as a possible contributing factor. We have explored whether this silence is connected with the staff’s hierarchical position and with the staff’s own experiences as patients abused in health care.

    Methods During January 2008, a paper questionnaire was sent to all staff members at a Swedish women’s clinic. The questionnaire included questions on sociodemography and profession and multiple questions about abuse in health care. After univariate testing, a binary logistic regression model including variables concerning profession and staff’s own experiences of abuse was built.

    Results Our data show that in contrast to midwives and gynaecologists, auxiliary nurses seldom report hearing about cases of abuse in health care. Staff who themselves experienced abuse in health care as patients, so-called wounded healers, were more likely to have heard about abuse in health care during the last 12 months.

    Conclusions This study suggests that a form of silence reigns over events of abuse in health care that is not randomly distributed over staff. Professional hierarchies and staff’s own experiences of abuse as patients could be considered in the design of interventions to break the silence surrounding patients’ experiences of abuse in health care.

  • 2.
    Helgesson, Gert
    et al.
    Karolinska Institutet, Sweden.
    Lindblad, Anna
    Karolinska Institutet, Sweden.
    Thulesius, Hans
    Lund university, Sweden;Region Kronoberg, Sweden.
    Lynöe, Niels
    Karolinska Institutet, Sweden.
    Reasoning about physician-assisted suicide: analysis of comments by physicians and the Swedish general public2009In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 4, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    Two questionnaires directed to Swedish physicians and a sample of the Swedish population investigated attitudes towards physician-assisted suicide (PAS). The aim of the present work was to analyse qualitative data from these questionnaires in order to explore how respondents reason about PAS. Data were analysed in two steps. First, we categorized different kinds of responses and identified pro and con arguments. Second, we identified general conclusions from the responses. The data reflect the differences in attitudes towards PAS among the public and physicians, with the former mainly in favour of PAS and the latter mainly against. There was, however, considerable agreement about what requirements must be met before PAS could be considered ethical. Many arguments against PAS concerned the professional role of physicians, which indicates that it may not be assisted suicide as such that many PAS opponents disagree with, but rather that it is handled by physicians in the regular health-care system.

  • 3.
    Svensson, Cecilia
    et al.
    South Älvsborg Hospital, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar County, Sweden.
    Holmberg, Mats
    Mälardalen University, Sweden;Region Sörmland, Sweden;Uppsala University, Sweden.
    Ambulance nurses’ experiences of patient relationships in urgent and emergency situations: a qualitative exploration2019In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 14, no 2, p. 70-79Article in journal (Refereed)
    Abstract [en]

    Background

    The ambulance service provides emergency care to meet the patient’s medical and nursing needs. Based on professional nursing values, this should be done within a caring relationship with a holistic approach as the opposite would risk suffering related to disengagement from the patient’s emotional and existential needs. However, knowledge is sparse on how ambulance personnel can meet caring needs and avoid suffering, particularly in conjunction with urgent and emergency situations.

    Aim

    The aim of the study was to explore ambulance nurses’ experiences of relationships with patients in urgent and emergency situations.

    Methods

    Data collection was performed using individual open-ended interviews with six ambulance nurses. The data were analyzed using a thematic analysis.

    Results

    Relationships with patients during urgent and emergency assignments emerged as three themes: “Ambiguous silence,” “Professional competence” and “Challenging inadequacy” comprising eight sub-themes in total. The result shows that the ambulance nurses found it difficult to prioritize between medical care and establishing a caring relationship with the patient. However, sometimes a wordless relationship was perceived sufficient and considered a first step towards a verbal relationship.

    Conclusions

    Ambulance nurses experience that a caring relationship cannot and does not need to be prioritized in the acute stage. This uncovers a dichotomy approach to medical care versus caring relationships that exclude a holistic approach. Thus, patients’ emotional, existential and physical needs are not considered as equally important.

    Clinical relevance: It is important to stimulate reflection on core ethical nursing values, in training and simulation exercises among clinically active ambulance nurses.

  • 4.
    Swahnberg, Katarina
    et al.
    Hälsouniversitetet, Linköping.
    Berterö, Carina
    Minimizing human dignity: staff perception of abuse in health care2012In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 7, no 1, p. 33-38Article in journal (Refereed)
    Abstract [en]

    In earlier studies we have shown that abuse in health care (AHC) is commonly reported among both male and female patients. In this study, we present an evaluation of an intervention against AHC based on Forum Play. The evaluation was conducted by means of pre- and postintervention interviews with the staff at a woman's clinic. The interviews were analysed using the constant comparative method. The results of this postintervention study stand out in loud contrast to the results of the preintervention studies. Staff had moved from a distant and fluctuating awareness of AHC to a standpoint characterized by both moral imagination and a sense of responsibility.

  • 5.
    Zbikowski, Anke
    et al.
    Linköping University.
    Zeiler, Kristin
    Linköping University.
    Swahnberg, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Forum Play as a method for learning ethical practice: a qualitative study among Swedish health care staff2016In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 11, no 1, p. 9-18Article in journal (Refereed)
    Abstract [en]

    Background In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care.

    Method Ten health-care workers participating in a Forum Play course took part in this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison.

    Results The analysis resulted in the core category "developing response–ability." It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency.

    Conclusion The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation.

  • 6.
    Ågård, Anders
    et al.
    Sahlgrenska University Hospital, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Sallin, Karl
    Uppsala University, Sweden.
    Engström, Ingemar
    Örebro University, Sweden.
    Ethical controversies in the process of formulating new national guidelines on cardiopulmonary resuscitation in Sweden2017In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 12, no 4, p. 174-179Article in journal (Refereed)
    Abstract [en]

    The Delegation for Medical Ethics within the Swedish Society of Medicine has taken the initiative to create national ethical guidelines on cardiopulmonary resuscitation. The reasons behind this initiative were indications of differences in the way decisions about cardiopulmonary resuscitation were made and documented and requests expressed by health- care professionals for new national ethical guidelines. During the process of creating the guidelines, a number of work- shops were held with representatives from the delegation and clinical experts from various branches of medicine. Several versions of the working document were sent to consultation bodies with requests for comments. We therefore believe that the final guidelines are well supported by the medical profession in Sweden. The purpose of this article is to present ethical issues on which it was difficult to reach consensus due to divergent opinions expressed by the people and organisations involved. The arguments for and against a particular point of view or wording in the text are presented. The main controversies were related to the following six issues; Determining whether or not cardiopulmonary resus- citation is beneficial for the patient – The presence of close loved ones during cardiopulmonary resuscitation – Performing cardiopulmonary resuscitation for the benefit of people other than the patient – Ambulance personnel’s mandate to decide not to initiate and to terminate cardiopulmonary resuscitation outside hospital – Limiting the length and content of cardiopulmonary resuscitation – Whether or not to specify a week of gestation before which cardio- pulmonary resuscitation should not be started. 

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