Criminal liability of health-care providers Abstract This diploma thesis focuses on the criminal liability of the health-care providers. Its main objective is to provide a comprehensive overview of the fundamental issues, such as who can be a provider, what is the definition of healthcare services and what are the possible conditions of criminal liability. Another aim is to provide an overview of selected offenses that can be committed in connection with providing healthcare services and summary of the relevant legislation in the United Kingdom of Great Britain and Northern Ireland and in the Federal Republic of Germany. In this thesis, I mostly use the methods of description, analysis and comparison. The thesis is divided into six chapters, which follow a logical order. The first chapter explains the key concepts. Specifically, it is the definition of healthcare services, facilities and providers, lege artis procedure, informed consent and criminal liability. The second chapter focus on the criminal liability of natural persons, on the definition of a criminal offence and also the relevant circumstances excluding liability from the provision of healthcare point of view. The third chapter deals with the criminal liability of legal persons and their possible exculpation. The fourth chapter analyses selected...

Bakgrund: Sexuell hälsa är en viktig del av folkhälsan och ses som en mänsklig rättighet. Patienter uttrycker behov av att samtala om sexuell hälsa och förväntningar finns på att få information från vårdgivare om ämnet.Syfte: Syftet med denna litteraturstudie var att beskriva patienters och vårdgivares erfarenheter av samtal om sexuell hälsa, med fokus på att identifiera förutsättningar för framgångsrika samtal och hinder för att samtalen sker.Metod: Studiens design är litteraturöversikt. Databassökning utfördes i PubMed och CINAHL. Kvalitetsgranskning och resultatanalys gjordes på utvalda studier.  Resultat: Totalt 14 kvalitativa studier ingår i resultatet. Fyra studier med patientperspektiv, åtta med vårdgivarperspektiv och två studier med både patient- och vårdgivarperspektiv. Tre huvudteman och 10 subteman identifierades. Patienter upplevde att samtalet om sexuell hälsa inte togs upp med vårdgivarna. Både patienter och vårdgivare beskrev att ansvaret för att initiera diskussioner om sexuell hälsa var vårdgivarens. Olika faktorer kunde påverka samtalet samt verktyg och resurser nämns hjälpa både patienter och vårdgivare att förbättra samtalet om sexuella hälsa.Slutsats: Samtal om sexuell hälsa mellan patienter och vårdgivare sker sällan. Otillräcklig kunskap om ämnet och tidsbrist är en del av anledningen. För att förbättra patienters erfarenheter kring samtal om sexuell hälsa behöver vårdgivare ta ansvar för att initiera samtalen, öka sin kunskap samt prioritera ämnet högre. Fler verktyg och resurser behövs för att underlätta samtalen. / Background: Sexual health is an important part of public health that can be seen as a human right. Patients express a need for conversations about sexual health and expect the health care provider to give them information about the subject. Aim: The aim of this study was to describe patients’ and health care providers’ experiences of conversations about sexual health, with a focus on prerequisites for successful conversations and barriers to them taking place.  Method: The design used in this study was a literature review. Database searches were done in PubMed and CINAHL. Quality checks and analysis of the results were done on the chosen articles. Results: Fourteen articles were included in the results. Four articles had a patient perspective, eight had a health care provider perspective and two were a combination of both. Three main themes and 10 subthemes were identified. Patients rarely experienced that health care providers started conversations about sexual health. Some patients and health care providers said that health care providers were responsible for initiating the conversation. Different factors affected the conversations and different tools and resources were suggested to help patients and health care providers improve conversations about sexual health.Conclusion: Conversations between patients and health care providers about sexual health were rarely brought up for reasons including a lack of knowledge and time for the health care providers. Health care providers need to take responsibility for initiating conversations about sexual health with patients, prioritizing the subject and increasing their knowledge. Tools and resources are needed to improve the conversations.

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Thesis (Ph.D. (Nursing Science)) -- University of Limpopo, 2018 / Introduction: Health care workers have a pivotal role in the management of Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) and their well-being is consequently crucial as it could impact negatively on the quality of caregiving. With the development of a care and support model, the needs of health care workers can be identified and catered for, and quality patient care will be rendered through well-cared and supported health care workers. Purpose: The purpose of this study was to develop a care and support model for health care providers of patients diagnosed with HIV and AIDS in the public hospitals of the Limpopo Province. A key step in the development of a model for care and support is to explore and describe the experiences of professional nurses regarding care and support they receive while providing care to HIV and AIDS patients in the public hospitals of Limpopo Province Methods: A qualitative, descriptive, exploratory and contextual design was the method used which guided the development of the model. The population of the study were the professional nurses in five public hospitals from each district of the Limpopo Province. These hospitals were selected because they all shared similar characteristics of having clinics where HIV and AIDS patients receive care. The sample was purposively selected. The sample size was 20 professional nurses which was determined by data saturation, meaning that four professional nurses who worked for 24 months or more per public hospital were selected. Data were collected through face-to-face interviews and an audiotape was used to record all unstructured interview sessions conducted. Analysis of data were done through using an open-coding method in accordance with Tech’s qualitative data methodology to develop a model. Results: The research findings revealed emotional and physical strain due to shortage of staff and heavy workload which was exacerbated by staff turnover and high absenteeism. Exhaustion, fatigue, development of work-related vi illnesses and increased level of stress were also challenges experienced which led to increased customer complaints and decreased quality of service provided to patients. Many professional nurses were not trained in the management of patients with HIV and AIDS, but were expected to execute their activities competently. There was also lack of counselling, debriefing sessions, recognition and rewarding systems for the health professionals who were taking care of those patients. Recommendations: This Care and Support Model provides strategies to be used by the managers in public hospitals of Limpopo Province to enhance care and support to health care providers of HIV and AIDS patients. The model should be implemented at various public hospitals throughout Limpopo Province and feedback provided so that it could be further developed and refined. Conclusion: The results indicated that health care providers of HIV and AIDS patients were deprived of the necessary care and support during provision of care to HIV and AIDS patients. A model for care and support as a strategy to assist the managers to offer care and support to health care providers of HIV and AIDS has been developed. The model is a contribution to the nursing management, the government and it serves as a guideline for improving the quality of patient care through well-cared and supported health care workers.

<p>The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science.</p><p>In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency.</p><p>The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB).</p><p>Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively.</p><p>Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control.</p><p>Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance.</p>

Black women mortality rates are perceived to be impacted by communication barriers, trust issues, and the lack of quality preventive health services. The purpose of this phenomenological study was to explore communication barriers and trust issues perceived by Black women when seeking preventive health services. HMB was used to identify public attitudes around receiving preventive health services and to construct each question based on perceived susceptibility and perceived severity of communication barriers and trust issues. An ecological model of the communication process was used as a framework to identify fundamental relationships between the Black female patients and health care providers. Data were collected using open-ended interview questions from Black women in public health and health care professions in southeast Texas (N=10). Results were coded and evaluated by thematic analysis. NVivo 10 software was used to store and manage data. Study findings showed 4 participants voiced their beliefs that their healthcare provider was somewhat apathetic when it came to addressing their health care needs, and 3 of the participants who visited a doctor's office within the last 12 months reportedly expressed having poor communication and trust issues with their health care provider. Emerged themes included lack of attentiveness from health care providers and lack of a comfortable atmosphere or bedside manner when receiving preventive health care services from their healthcare provider. This research has implications for social change if the health inequalities of Black women are identified and addressed, then Black women may have a reduction in health disparities when receiving preventive health services and an increase healthier outcomes.

The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science. In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency. The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB). Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively. Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control. Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance. / Syftet med denna undersökning var att tydliggöra och beskriva de patienter som avbrutit sitt deltagande och/eller deltagit sällan i en behandling med sjukgymnastik baserad på egen aktivitet och eget ansvar. En ambition var att förstå fenomenet följsamhet utifrån några olika teoretiska perspektiv inom såväl beteende- som samhällsvetenskap. I Delstudie I studerades fenomenet följsamhet i relation till beteendeaspekter avseende patientuppfattningar om styrmekanismer som påverkar den egna hälsan (HLC) och patientupplevda hälsohot och hälsohotens konsekvenser (HB). Denna delstudie bygger på frågeformulär, som besvarades av samtliga patienter innan behandlingsstart. De frågor som mäter patientens uppfattningar om vad som styr den egna hälsan och frågor som mäter patientupplevda hälsohot och hälsoerfarenheter har bearbetats. Definitionerna på följsamhet var dels fullföljd träningsperiod, dels träningsfrekvens. De patienter som genomförde träningen jämfördes med de som avbröt den. De som genomförde träningen studerades dessutom avseende träningsfrekvens. Resultatet i Delstudie I visade att de som avbröt sin behandling, rapporterade större hot av sitt hälsotillstånd (högre smärtintensitet) och större konsekvenser av hälsotillståndet (sämre funktionsförmåga, sämre allmänt hälsotillstånd) än de som genomförde den. Resultatet visade dessutom att de som tränade en gång i veckan eller mer sällan hade värderat vårdsituationens betydelse lägre (HLC), upplevde större hot av sitt hälsotillstånd (högre smärtintensitet), större konsekvenser av hälsotillståndet (större funktionsnedsättning, sämre allmänt hälsotillstånd, större besvärsutbredning), fler hinder för behandlingen (lägre förväntningar) och uppvisade andra demografiska faktorer (yngre individer, fler kvinnor) än de som tränade oftare (HB). I Delstudie II studerades hur patienter själva beskriver anledningen till avbrott i behandlingen, om dessa anledningar kan variera och hur de varierar. Sexton patienter som avbrutit sin behandling intervjuades med öppna frågor. Intervjun inleddes med en fråga om bakgrunden till den sjukgymnastiska behandlingen. De ställdes inför frågor som hade anknytning till genom!örandet av behandlingen och vad de trodde själva om sina besvär. Frågor om patienternas prioriteringar i vardagen ingick, vilka antogs kunna utgöra hinder för behandling under en kortare eller längre tid. Ett tredje område som ingick, rörde deras erfarenheter av patient/sjukgymnast relationen. Intervjuerna analyserades kvalitativt. Analysen i Delstudie II resulterade i att fyra olika beskrivningar av orsaker till avbrott i behandlingen genererades. A) Det var dags att avsluta och gå vidare på egen hand. B) Behandlingen var inte det viktigaste att lägga sin tid på. C) Överenskommelse med sjukgymnasten att avbryta behandlingen på grund av uteblivna resultat. D) Avsaknad av ställningstagande till avbrott i behandlingen. Vid en fårdjupadanalys av kategori D framstod att denna grupp erfar olika former av maktlöshet. Det yttrade sig i beskrivningar av att deras trovärdighet ofta är ifrågasatt, att deras livssituation är en ständig frustration där andra tar de viktiga besluten och där de själva inte har mycket att säga till om, samt att de värjer sig mot att berätta om sina fåreställningar om vad de själva tror besvären beror på och vad man gör åt dem. Vid en jämförelse mellan kategori D och A, B, C har kategorierna A, B och C varierande grad av kontroll i olika situationer medan kategori D saknar kontroll.

This thesis focuses on the protection of the patient’s privacy in health care in Sweden. It is crucially important that the patient has confidence in the health care and that patient data are kept secret from other persons and authorities. A patient who is unsure about secrecy and confidentiality may choose not to provide data that could prove necessary for health care personnel to arrive at an accurate diagnosis. Some individuals might even avoid seeking medical help from fear that data may be spread to outsiders. Inadequate protection of sensitive data may lead to the confidence of citizens in health care eventually eroding or vanishing completely. Protection of patient privacy is thus of fundamental importance in this area. In the area of health care, the intention of the legislator is that the regulations regarding secrecy in public health care and confidentiality in private health care will guarantee protection of patient privacy. Secrecy in public health care is regulated mainly in Chapter 25, Section 1 of the Swedish Public Access to Information and Secrecy Act (2009:400). In private health care, confidentiality is regulated mainly in Chapter 6, Section 12, first paragraph, and Section 16 of the Swedish Act on Patient Safety (2010:659). The overall purpose of the thesis is to examine and analyse the legislator’s intentions and the juridical construction regarding the rules of secrecy and confidentiality, from the perspective of patient privacy. The starting point of the thesis is that the patient’s privacy should be strongly protected. One of the main conclusions is that the legal construction cannot be considered to be in accordance with the legislator’s intention that the regulation of patient privacy protection should constitute a strong protection for the patient’s privacy, be comprehensible, clear and easy to apply for health care personnel, as well as being the same in both public and private health care.

PURPOSE: The main aim of this study was to develop guidelines for prevention of hypertension among adults in Hawassa City, Ethiopia. METHOD: The study used mixed methods approach. In Phase 1, a quantitative community-based comparative cross-sectional survey was used to establish the burden of hypertension and its determinant factors in the urban and peri-urban areas. The survey was meant to describe adult’s knowledge and attitudes regarding hypertension risky behaviour and its prevention. Secondly, in the qualitative phase, focus group discussion (FGD) among health care providers of selected sub-cities of the first phase of the study was conducted to explore their perspectives towards efforts exerted for the prevention of hypertension. Thirdly, based on the findings of the two phases of the study, review of literatures, the researcher’s insights and exploring expertise opinion using a Delphi technique, a guideline for hypertension prevention among adults was developed. RESULTS: The overall prevalence of hypertension was 21.2%, higher in the urban setting (24.5%) than the peri-urban (14.7%) (x2=7.81 and p-value 0.003). Fifty-five (55) of the hypertensive participants were newly screened. In the urban setting age, wealth, use of top added salt on plate, mode of transport, family history of hypertension, ever-told have diabetes and body mass index were significantly association with hypertension. In the peri-urban setting age, sex, vegetable eating habit, performing physical fitness activities and family history of hypertension showed significantly association with hypertension. Regarding knowledge of hypertension risky behaviour and prevention, 46.1% (n=282) of the respondents were with “low”, 37.6% (n=230) with “medium” and 16.3% (n=100) with “high” level of knowledge on hypertension risky behaviour and prevention. The majority of respondents demonstrated positive attitude toward perceived susceptibility and perceived severity whereas the minority had poor attitude toward their perceived benefit of applying hypertension prevention. In the qualitative study, four themes and 12 sub-themes emerged, which explored health care providers’ perspectives regarding efforts exerted for the prevention of hypertension In conclusion prevalence of hypertension is high and has become a public health problem but activities done on the prevention are minimal. Guidelines developed from this research, if utilised, will assist in lessening the burden of hypertension in Ethiopia among adults. / Health Studies / D. Litt. et Phil. (Health Studies)

Various forms of complementary and alternative medicine (CAM) are increasingly being used in the United States and globally over time. Among CAM, natural products, including herbal medicines, are the most used type. However, the increase in the use of CAM has gone on with minimal or without a corresponding increase in the rate of disclosure of use to the health care providers. The theories of care-seeking behavior and the behavioral model of health services use guided most of the study. Data from the 2012 National Health Interview Survey were analyzed to determine the health factors that affect the nondisclosure of herbal medicine usage by respondents (N = 423) who used herbs as their first choice of CAM therapy. Data were analyzed using descriptive statistics and a binary logistic model. About one quarter of herb users did not disclose their use of herbs to the health care provider. Nondisclosures were likely to be associated with herb users who also used homeopathy and those who used herbs to treat diseases that are usually short-term. The nondisclosure rate of the use of CAM, including herbal therapy, remains a recurring concern. As part of the practical implications, the study creates and supports the awareness of health factors associated with CAM and herbal medicine use nondisclosure issues that inform health professionals about mitigating the problem and improving health practice and medical consultations.