12 September 2018

Abuse in healthcare is a hidden problem we should be able to deal with. But the system is reluctant to discuss the problem openly. This is the view of Barbro Wijma, senior professor at LiU with over 20 years’ research experience of the subject.

Health care
Research at Linköping University shows that one in five female patients and nearly one in ten male patients has at some time experienced abuse in healthcare. It can be in the form of demeaning comments or a nonchalant attitude, or abuse that healthcare personnel are not aware they are committing.

“Despite the intention of personnel to behave well, it happens far too often that patients experience themselves as being abused. I too have exposed patients to it in my role as doctor, without understanding what I was doing”, says Barbro Wijma.

The LiU research into abuse has been financed during the past 20 years mainly by the Swedish Research Council, and Barbro Wijma has been one of the leading researchers in the field. One conclusion from the study is that people who have previously been subject to abuse or violence are more sensitive to excesses from the healthcare system.

“If you have high self-esteem, it’s easier to shake off abuse, and not let it get to you. Others, often carrying poor self-esteem in their baggage, may be extremely distressed, feel that they have been trampled on, and for this reason avoid further contact with the system.”

Barbro Wijma returns to the idea that caregivers have no desire to abuse patients, and they must be made aware that they may be doing so unconsciously. From thoughtlessness, stress, or unfortunate circumstances, for example.

“The healthcare personnel should truly listen to what a patient who feels abused has to say. They must not attempt to belittle the event, with a statement such as ‘Well, it wasn’t that bad, was it?’, or start an argument. It is, instead, important to affirm the patient’s experience. In this case, he or she is vindicated and will find it easier to leave the event behind.”

In recent years, the research group has concentrated on disseminating knowledge about abuse to healthcare personnel. Jelmer Brüggemann and Alma Persson from the Department of Thematic Studies at LiU have participated in this work.

“Our research has shown that healthcare personnel recognise several situations of abuse when they occur in their work, but find it difficult to deal with them in a professional manner. In their relationship both to patients and colleagues, the reaction is often one of silence, and many feel guilt and shame”, says Jelmer Brüggemann.

In order to bring these issues to the fore and transfer knowledge about abuse, the researchers have enlisted the aid of a drama teacher and carried out workshops at several clinics, including clinics of gynaecology, psychiatry and palliative care.

“This is a way to go beyond simply talking about abuse: we use different scenarios in the clinic to understand the processes that are set in motion. Much of the material also deals with what one can do as a colleague to stop abuse and violation. Many situations are difficult for the healthcare personnel to deal with, such as how to act when a patient doesn’t want to be washed or refuses to have an injection”, says Alma Persson.

The research project is now coming to a close after 20 years. In order to spread knowledge about its results, the researchers have contacted several government agencies, including the Swedish Association of Local Authorities and Regions (SKL), which is building a website about abuse in the healthcare system, using the LiU results as one of the fundamental pillars. Barbro Wijma will present the experiences of the research group at a Swedish conference on patient safety in Stockholm, 19-20 September.

Translation: George Farrants

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