[Abuse in healthcare - lessons learned during two decades of research]. / Kränkningar i vården är vanligt förekommande - Viktigt med aktivt arbete mot att patienter kränks.

Patients' experience of abuse in health care (AHC) is common, and may cause long-lasting suffering. In Sweden, lifetime prevalence is estimated at 20 per cent among female patients and 8 per cent among male patients, and a background of other abuse is a risk factor. Most health care staff have experience of patients who have been abused, but the topic is surrounded by silence from both patients and caregivers. Models for training staff in groups have been evaluated and a more proactive stance can be fostered. Department heads and health care authorities are responsible for providing staff with options to counteract AHC. Caregivers need training in how to carry out consultations with patients who say they have been abused in health care, and this training should be included in efforts to increase quality of care. Changes are within reach but educational efforts are urgent.

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

In their everyday work, health professionals find themselves in situations that they perceive to be abusive to patients. Such situations can trigger feelings of shame and guilt, making efforts to address the problem among colleagues a challenge. This article analyzes how health professionals conceptualize abusive situations, and how they develop collective learning and explore preventive strategies. It is based on an interactive research collaboration with a hospice and palliative care clinic in Sweden during 2016-2017. The empirical material consists of group discussions and participant observations collected during interactive drama workshops for all clinic staff. Based on three types of challenges in the material, identified through thematic analysis, we establish the concept of navigation work to show how health professionals prevent or find ways out of challenging and potentially abusive situations. First, the navigation of care landscapes shows how staff navigate the different territories of the home and the ward, reflecting how spatial settings construct the scope of care and what professionals consider to be potentially abusive situations. Second, the negotiation of collective navigations addresses the professionals' shared efforts to protect patients through the use of physical and relational boundaries, or mediating disrupted relationships. Third, the navigation of tensions in care highlights professionals' strategies in the confined action space between coercing and neglecting patients who oppose necessary care procedures. Theoretically, the concept of navigation work draws upon work on care in practice, and sheds light on the particular kind of work care professionals do, and reflect on doing, in order to navigate the challenges of potentially abusive situations. By providing a perspective and shared vocabulary, the concept may also elicit ways in which this work can be verbalized, shared, and developed in clinical practice.

LGBT in the Military: Policy Development in Sweden 1944-2014.

This article contributes to the growing field of research on military LGBT policy development by exploring the case of Sweden, a non-NATO-member nation regarded as one of the most progressive in terms of the inclusion of LGBT personnel. Drawing on extensive archival work, the article shows that the story of LGBT policy development in the Swedish Armed Forces from 1944 to 2014 is one of long periods of status quo and relative silence, interrupted by leaps of rapid change, occasionally followed by the re-appearance of discriminatory policy. The analysis brings out two periods of significant change, 1971-1979 and 2000-2009, here described as turns in LGBT policy. During the first turn, the military medical regulation protocol's recommendation to exempt gay men from military service was the key issue. During these years, homosexuality was classified as mental illness, but in the military context it was largely framed in terms of security threats, both on a national level (due to the risk of blackmail) and for the individual homosexual (due to the homophobic military environment). In the second turn, the focus was increasingly shifted from the LGBT individual to the structures, targeting the military organization itself. Furthermore, the analysis shows that there was no ban against LGBT people serving in the Swedish Armed Forces, but that ways of understanding and regulating sexual orientation and gender identity have nonetheless shaped the military organization in fundamental ways, and continue to do so.

Using forum play to prevent abuse in health care organizations: A qualitative study exploring potentials and limitations for learning.

BACKGROUND: Abuse in health care organizations is a pressing issue for caregivers. Forum play, a participatory theater model, has been used among health care staff to learn about and work against abuse. This small-scale qualitative study aims to explore how forum play participants experience the potentials and limitations of forum play as an educational model for continued professional learning at a hospital clinic. METHODS: Fifteen of 41 members of staff of a Swedish nephrology clinic, primarily nurses, voluntarily participated in either one or two forum play workshops, where they shared experiences and together practiced working against abuse in everyday health care situations. Interviews were conducted after the workshops with 14 of the participants, where they were asked to reflect on their own and others' participation or nonparticipation, and changes in their individual and collective understanding of abuse in health care. RESULTS: Before the workshops, the informants were either hesitant or very enthusiastic toward the drama-oriented form of learning. Afterward, they all agreed that forum play was a very effective way of individual as well as collective learning about abuse in health care. However, they saw little effect on their work at the clinic, primarily understood as a consequence of the fact that many of their colleagues did not take part in the workshops. DISCUSSION: This study, based on the analysis of forum play efforts at a single hospital clinic, suggests that forum play can be an innovative educational model that creates a space for reflection and learning in health care practices. It might be especially fruitful when a sensitive topic, such as abuse in health care, is the target of change. However, for the effects to reach beyond individual insights and a shared understanding among a small group of participants, strategies to include all members of staff need to be explored.