The article traces the history of the Poly Implant Prosthesis (PIP) scandal from an ethical perspective and explores the underpinning moral dilemmas inherent in the act of ‘whistleblowing.’ It goes on to consider the consequential stakeholder and broader societal reaction to whistleblowing which is discussed through deontological and teleological perspectives of ethically driven motives to act. It draws on the duty of care responsibility of healthcare professionals and the dilemma of personal consequence by the act of whistleblowing, whereby the objective of that act is the maintenance or improvement of patient standards and care. It argues that a cultural shift in organisational behaviour is urgently required to abrogate the needs for whistleblowing by means of internal systems and processes. Whistleblowing would thus become a supererogatory act of moral courage rather than carrying negative consequences in the interests of short-term saving face.

Bakgrund När barn är inneliggande på sjukhus så deltar ofta föräldrarna i omvårdnaden enligt vårdfilosofin familjecentrerad omvårdnad. Detta är oftast positivt både för föräldrar och barn men det kan även leda till svårigheter i mötet mellan föräldrar och vårdpersonal eftersom de ska dela på omvårdnadsansvaret. För att föräldrar ska känna sig trygga i detta bör vårdpersonalen uppmuntra deras egenmakt. Genom att föräldrarna upplever mötet positivt kan ett partnerskap mellan vårdpersonal och föräldrar skapas. Syfte Syftet var att belysa hur föräldrar till barn som är inneliggande på sjukhus upplever mötet med vårdpersonalen. Metod Studiedesignen var en litteraturöversikt som baserades på 21 vetenskapliga originalartiklar med både kvalitativ och kvantitativ ansats. Databaserna PubMed och CINAHL användes för datainsamling och artiklarna inhämtades genom att sökord kombinerades ihop i sökblock. Artiklarna har kvalitetsgranskats utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. En integrerad dataanalys genomfördes. Resultat Resultatet sammanställdes i fyra huvudkategorier; relationsskapande möten, information i mötet, roller i mötet samt känslor och behov i mötet. Resultatet visade till exempel att föräldrarna fann det betydelsefullt att vårdpersonalen var förtroendeingivande, visade respekt och kunde fungera som guider. Andra viktiga förmågor var att kunna kommunicera och delge information på ett anpassat sätt och att de kunde hjälpa föräldrarna att hitta och känna sig trygga i sin roll samt hjälpa dem att hantera sina känslor. Slutsats Föräldrar upplevde att kvaliteten på mötet med vårdpersonalen i hög utsträckning kunde påverka deras känsla av egenmakt och hur de kunde hantera sina känslor. Genom att mötet anpassas efter deras önskemål och förutsättningar kan föräldrarna öka sin delaktighet i omvårdnaden och på så sätt kan ett gynnsamt partnerskap etableras. / Background When children are hospitalized, parents often participate in the care, in accordance with the nursing philosophy of family-centered care. This is usually beneficial for both parents and children, but it can also lead to difficulties in the encounter between parents and healthcare professionals as they share the responsibility of care. To make parents feel secure in this, healthcare professionals should encourage their empowerment. By ensuring that parents have a positive experience when interacting with healthcare professionals, a partnership between healthcare professionals and parents can be established. Aim The aim was to highlight how parents to hospitalized children experience the encounter with the healthcare professionals. Method The study design was a literature review which was conducted, based on 21 scientific original articles with both qualitative and quantitative approaches. The databases PubMed and CINAHL were used for data collection, and articles were retrieved by combining keywords in search blocks. The articles were assessed for quality based on the evaluation criteria from Sophiahemmet Högskola for scientific classification and quality. An integrated data analysis was performed. Results The results were compiled into four main categories: relationship-building encounters, information in the encounter, roles in the encounter, and emotions and needs in the encounter. The results showed, for example, that parents found it significant that healthcare professionals were trustworthy, showed respect, and could serve as guides. Other important abilities included being able to communicate and provide information in an appropriate manner and helping parents find and feel secure in their roles, as well as assisting them in managing their emotions. Conclusions Parents experienced that the quality of the encounter with healthcare professionals could affect their sense of empowerment and how they could manage their emotions. By adapting the encounter to their preferences and circumstances, parents can increase their participation in caregiving, enabling a beneficial partnership to be established.

Bakgrund: Substansbrukssyndrom drabbar människor över hela världen. Tidigare forskning har visat att hälso- och sjukvårdspersonal upplevde att de hade en negativ inställning till patienter med substansbrukssyndrom. Hälso-och sjukvårdspersonal har också rapporterats ha fördomar mot denna patientgrupp. Det har även visats att patienter med substansbrukssyndrom behandlades annorlunda än andra patienter. Patienter med substansbrukssyndrom vårdas på många olika avdelningar, vilket gör att den grundutbildade sjuksköterskan kan möta dessa patienter inom olika vårdinstanser. Syfte: Syftet med litteraturstudien var att belysa vilka erfarenheter patienter med substansbrukssyndrom hade av mötet med hälso- och sjukvårdspersonal. Metod: En litteraturstudie baserad på tolv vetenskapliga artiklar med kvalitativ studiedesign. Artiklarna hämtades från databaserna Cinahl, Pubmed och Psychinfo. Artiklarna analyserades enligt metod beskriven av Friberg (2017). Resultat: Två teman identifierades: Positiva upplevelser samt Negativa upplevelser. Utifrån dessa genererades fyra subteman: Professionellt bemötande, Terapeutisk allians, Oprofessionellt bemötande och Inadekvat vård. Konklusion: Patienterna hade både positiva och negativa erfarenheter av möten med hälso- och sjukvårdspersonal. Vid positiva upplevelser beskrevs ett fördomsfritt och accepterande bemötande samt att hälso- och sjukvårdspersonal skapade en anknytning till patienten och gjorde patienten delaktig i vården. Vid negativa erfarenheter skildrades bemötandet som fördomsfullt, dömande och stigmatiserande. Hälso- och sjukvårdspersonal upplevdes ofta ha bristande kunskaper inom beroendemedicin. Patienter med substansbrukssyndrom upplevde att de fick sämre vård än patienter utan substansbrukssyndrom. Hälso- och sjukvårdspersonal behöver ha kunskap inom beroendemedicin samt ett professionellt och fördomsfritt bemötande för att kunna ge patienter med substansbrukssyndrom en god och likvärdig vård som andra patienter. / Background: Substance use disorder affects people all over the world. Previous research showed that health care professionals had a negative attitude towards patients with substance use disorder. They also had prejudices against this patient group. Patients with substance use disorder were treated differently than other patients. They are cared for in many different wards, which means that the undergraduate nurse can meet these patients in different care institutions. Aim: The purpose of the literature study was to illustrate the experiences of patients with substance use disorder meeting health care professionals. Method: A literature study based on twelve scientific articles with qualitative study design. The articles were retrieved from the databases Cinahl, Pubmed and Psychinfo and were analyzed according to Friberg (2017). Result: Two themes were identified: Positive experiences and Negative experiences. Based on these, four subthemes were generated: Professional attitude, Therapeutic alliance, Unprofessional attitude and Inadequate care. Conclusion: Patients had both positive and negative experiences of meetings with health care professionals. In positive experiences, an open-minded and accepting attitude was described and health care professionals created a connection to the patient and involved patients in the care. In negative experiences, the attitude was portrayed as prejudiced, judgmental and stigmatizing. Healthcare professionals often had a lack of knowledge in addiction medicine. Patients with substance use disorder experienced that they received inferior care than patients without substance use disorder. Healthcare professionals need to have knowledge in addiction medicine as well as a professional and open-minded attitude to be able to give patients with substance use disorder a good and equivalent care as other patients.

No description available.

Yes / Objective: To better understand the factors influencing the uptake of direct oral anticoagulants (DOACs) across different health economies in National Health Service England from the perspective of health professionals and other health economy stakeholders. Design: Qualitative interview study using a critical realism perspective and informed by the Diffusion of Innovations in Service Organisations model. Setting: Three health economies in the North of England, United Kingdom. Participants: Healthcare professionals involved in the management of patients requiring oral anticoagulants, stakeholders involved in the implementation of DOACs and representatives of pharmaceutical industry companies and patient support groups. Intervention: Semistructured interviews (face-to-face or telephone) were conducted with 46 participants. Interviews were analysed using the Framework method. Results: Identified factors having an impact on the uptake of DOACs were grouped into four themes: perceived value of the innovation, clinician practice environment, local health economy readiness for change, and the external health service context. Together, these factors influenced what therapy options were offered and prescribed to patients with atrial fibrillation. The interviews also highlighted strategies used to improve or restrict the uptake of DOACs and tensions between providing patient-centred care and managing financial implications for commissioners. Conclusions: The findings contribute to the wider literature by providing a new and in-depth understanding on the uptake of DOACs. The findings may be applicable to other new medicines used in chronic health conditions. / This work presents research funded by the Pharmacy Research UK (grant number: PRUK-2018-GA-1-KM) and Leeds Teaching Hospitals NHS Trust (grant number: N/A).

yes / The Health Care and Professions Council (HCPC) regulates fifteen different professions; some of these are large groups like Physiotherapists and some are much smaller such as Speech and Language Therapists (SLT). Most of the people registered by the HCPC work within their own areas of clinical expertise and defined professional scope of practice. However, an increasing number of registrants are undertaking new or additional roles beyond the traditional scope of practice for the defined profession. These roles are often shared with other medical or health professionals and persons undertaking these roles are often, but not consistently, referred to as Advanced Practitioners. Advanced Practitioners are employed within the NHS across all four countries of the UK and are also employed by private healthcare providers. The roles they undertake vary from the highly specialised (e.g. an advanced podiatrist might specialise in biomechanics) to more general roles with greater professional autonomy and decision-making (e.g. a paramedic working in a GP Practice assessing patients with undifferentiated acute problems). As a result, there is currently no consistency in role title, scope of advanced practice, necessary underpinning education or professional accreditation across the HCPC registered professions. This study was undertaken to explore these issues and seek opinion on the need for additional regulatory measures for persons working at an advanced practice level. NB: For the purposes of this study, advanced practice was considered to encompass all roles, regardless of role title, where the level of practice undertaken was considered to be advanced. Method Three approaches to data collection were undertaken to ensure the differing opinions across all HCPC registered professions, different stakeholders and the four nations of the UK were collected. Data were collected through: 1. A UK wide survey of HCPC registered healthcare professionals; 2. A UK wide survey of organisations delivering AHP & scientific advanced practice education; 3. A series of focus groups and interviews across a range of stakeholder groups. Findings The concept of advanced level practice was not consistently understood or interpreted across the different stakeholder groups. Those participants identifying as working at an advanced practice level undertook a range of activities both within and out with the traditional scope of practice of the registered profession adding a further layer of complexity. Educational support and availability for advanced level practice varied across professional groups and inequity of accessibility and appropriateness of content were raised as concerns. There is no consensus across participant groups on the need for regulation of advanced level practice. Perceived advantages to additional regulation were the consistent and equal educational and employer governance expectations, particularly where multiple professional groups are undertaking the same role, all be it with a differing professional educational foundation and lens. However, while some voices across the participant groups felt regulation was essential to assure practice standards and reduce risk of role title misuse, there was equally a lack of appetite for regulation that inhibited agility to respond to, and reflect, the rapidly changing healthcare environment and evolving scope of advanced level practice. Importantly, no evidence was presented from any participant group that advanced level practice within HCPC regulated professions presents a risk to the public. Conclusion The study data presented in this report reflect the complexity of the concept of advanced practice within the HCPC regulated professions. Much of this is a consequence of the differing speeds of professional role development across healthcare organisations and professional groups, often related to service capacity gaps and locally developed education to support local initiatives. Despite this, there is no clear evidence, based on the findings of this research, that additional regulation of advanced level practice is needed, or desired, to protect the public. However, as the HCPC is one of the few organisations with a UK wide remit, it may have a central role in achieving unification across the 4 nations in relation to the future role expectations, educational standards, and governance of advanced level practice.

Alkohol och droger finns och används världen över och kan ibland leda till ett beroende, detta kan för de drabbade personerna innebära ett stort antal kontakter med vården. Syftet med studien var att beskriva vårdpersonalens attityder gentemot patienter med missbruksproblematik genom en integrativ litteraturöversikt, detta gjordes genom att söka i ett flertal databaser. Med hjälp av inklusions- och exklusionskriterier framkom 15 artiklar som upplevdes svara på syftet och därefter utfördes en analys baserat på Kristenssons analysförfarande där meningsbärande enheter kondenserades till kategorier, koder och underkategorier.  Resultatet visade att ett flertal av vårdpersonalen i studierna hade negativa attityder gentemot personer med missbruk. Det uppgavs även att det kan finnas flera olika faktorer som påverkar, som kan göra att attityderna kan vara negativt eller positivt laddade, till exempel genom olika erfarenheter som kan vara både av personlig och professionell karaktär. Vårdpersonalens attityder kan genomsyras av negativitet och rädsla men även av en tilltro till patienten och dennes möjligheter till välmående.  Genom våra resultat har vi dragit slutsatsen att negativa attityder gentemot patienter med missbruksproblematik finns hos vårdpersonal världen över och detta kan leda till negativa upplevelser av vården samt att patienten därigenom inte alltid får den vård som vore önskvärd. Attityder kan påverkas av tidigare erfarenheter och kan då både påverkas att bli negativa eller positiva och för att förbättra attityderna gentemot dessa patienter och för att en god vård ska kunna ske behövs mer utbildning, som i sin tur kan ge en ökad förståelse för behoven i vården. / Alcohol and drugs can be found and are used worldwide and can sometimes lead to an addiction, which for the affected persons can mean a large number of contacts with healthcare. The purpose of this study was to describe the healthcare personnels attitudes towards patients with addiction problems through an integrative literature review. This was done by searching a number of databases. With the help of inclusion and exclusion criteria, 15 articles appeared that were felt to answer the purpose and then an analysis was performed based on Kristensson's analysis procedure where meaningful units were condensed into categories, codes and subcategories.  The results showed that a majority of the healthcare personnel in the studies had negative attitudes towards people with an addiction. It was also stated that there can be several different influencing factors that can cause the attitudes to be negative or positive, for example through different experiences that can be both of a personal and professional nature. The attitudes of the healthcare staff can be permeated by negativity and fear, but also by a belief in the patient and his possibilities for well-being.  Our conclusion is that negative attitudes towards patients with addiction problems exist among healthcare personnel worldwide and this can lead to negative experiences of the care and that the patient thereby does not always receive the care that would be desirable. Attitudes can be influenced by previous experiences and can create both negative and positive attitudes, To improve attitudes towards these patients and for good care to take place, more education is needed, which in turn can provide an increased understanding of the needs in care.

Bakgrund: Det finns ett växande intresse för att tillhandahålla palliativ vård för personer med intellektuell funktionsnedsättning, och därmed ett erkännande av deras särskilda behov och svårigheter att få tillgång till rättvis vård i livets slutskede. Detta ställer krav på att vårdpersonal ska kunna identifiera palliativa behov, samt inte minst bedöma när livets slut närmar sig. Denna kunskap gynnar både individen och hela samhället. Då tillgången till palliativ vård för personer med intellektuell funktionsnedsättning är sämre än för övrig befolkning sökte denna litteraturstudie identifierade orsaker till denna ojämlikhet. Syfte: Att beskriva vårdpersonals upplevelser av faktorer som möjliggör och försvårar palliativ vård för personer med intellektuell funktionsnedsättning. Metod: Studien är en litteraturöversikt. En tematisk analys med induktiv ansats genomfördes där inkluderade artiklar analyserats utifrån Braun och Clarkes tematiska analysmetod. Totalt valdes 14 artiklar ut från databaserna CINAHL och PubMed. Resultat: I resultatet framkom fem huvudteman – hur etiska värderingar påverkar vårdpersonals upplevelser av palliativ vård, kunskapsnivåns betydelse för möjligheten att ge god palliativ vård, de praktiska förutsättningar som arbetsgivare tillhandahåller, vårdpersonals upplevelse av hur närstående påverkar den palliativa vården samt hur vårdpersonals känslor påverkar deras upplevelse av att ge palliativ vård – vilka belyste vårdpersonalens erfarenheter. Slutsats: Resultatet visade både hinder och möjligheter för palliativ vård för personer med intellektuell funktionsnedsättning. Vårdpersonalens upplevelser präglas av ett fokus på hinder där bristande utbildning samt bristande samarbete tydligast försämrar möjligheten till jämlik vård till patientgruppen. Utifrån dessa resultat finns förutsättningar att utveckla framtida vård. / Background: There is a growing interest in providing palliative care for people with intellectual disabilities, and as a consequence a growing interest in recognizing their special needs and difficulties in accessing equitable end-of-life care. This places demands on healthcare staff to be able to identify palliative needs, not least to assess when the end of life is approaching. This knowledge benefits both the individual and society as a whole. As palliative care for people with intellectual disabilities is less avaliable than for the rest of the population, this literature study looked for identified reasons for this inequality. Aim: To discribe healthcare professional’s experperinces of factors that facilitates or hinder palliative care for people with intellectual disabilities. Method: This study is a literature review. A thematic analysis with an inductive approach was carried out, where included articles were analyzed using Braun and Clarke's thematic analysis method. A total of 14 articles were selected from the databases CINAHL and PubMed. Results: Five main themes emerged in the result – How ethical values affect the way healthcare professional´s experiences palliative care,  How the level of knowledge impacts the possibility to provide good palliative care, The practical conditions that an employer offers, How healthcare professionals experience the impact of the patients' family members on the palliative care and How the emotions of the healthcare professional’s affects their experience of providing palliative care – which illuminated the experiences of the healthcare professionals.  Conclusion: The result showed both obstacles and opportunities for palliative care for persons with intellectual disabilities. The healthcare professionals' experience is characterized by a focus on obstacles, where insufficient training and cooperation are the most prominent factors in making it more difficult to provide equal care for the patient group. Based on these results there are possibilities to develope future care.

This paper provides an analysis of Bradshaw and Colleagues' model of military healthcare professionals' moral distress experiences. Using novel interview data collected from Canadian Forces healthcare professionals, the steps of the model are validated or potential refinements are suggested. / Military healthcare professionals (HCPs) may experience moral distress during international deployment. Moral distress is experienced when a HCP faces a moral dilemma, e.g., knows the morally correct course of action but is blocked from taking it, or where all available courses of action require something of moral significance be given up. While the literature indicates that moral distress often negatively impacts the mental health of the individual and the effectiveness of the organization, limited research has examined moral distress amongst military HCP. Many similar stressors and psychological health problems are present for both civilian and military HCP; however, the unique context of deployment necessitates further examination. This thesis explores the military HCP experience with moral distress by using Bradshaw and colleague’s model of progression from the encounter with a moral dilemma to the impact on individuals and organizations. Through the analysis of novel interviews collected by the Ethics in Military Medicine Research Group (EMMRG), Bradshaw and colleague’s model of military moral distress is compared to participant’s experiences and qualitatively analysed, with the results outlining where the model is supported and where refinement is recommended. These challenges were then supported by a literature review from the disciplines of virtue and feminist ethics, moral psychology, bioethics, and civilian HCP moral distress research. Two novel and significant revisions to the model are suggested: representing and integrating the cumulative experience of moral distress, and re-conceptualizing the resolution process based on the consideration of contextual controllability on moral responsibility. / Thesis / Master of Science (MS) / This thesis examines the experience of moral distress in military healthcare professionals (HCPs) while working abroad, where a HCP faces a moral dilemma, e.g., knows the morally correct course of action but is blocked from taking it or it requires something of moral significance be given up. This thesis analyses the most recent model of military HCP moral distress (Bradshaw, et al., 2010) by comparing it to the experiences described by participants in the Ethics in Military Medicine Research Group (EMMRG) study. The results outline support for the model as well as novel suggestions for revision, which are supported by literature from a variety of disciplines. Two adjustments to Bradshaw and colleague’s model are suggested: clearer representation of the cumulative nature of moral distress as well as a reconceptualization of the resolution process to consider the influence of the immediate and extended environment on moral responsibility.

Cancer is a potentially life-threatening disease, which affects millions of people worldwide. It is multifaceted in nature and can lead to impairment in a person‟s physical, social and emotional functioning (Beatty, Oxlad, Koczwara, & Wade, 2008). Multidimensional treatment, with highly specialised professionals, equipment and services is thus needed for the effective treatment thereof (Mathews, West, & Buehler, 2009). Patients treated within the private and public healthcare sectors of South Africa have vastly differing treatment experiences. Only about 20% of the South African population has access to and can afford treatment within the private healthcare sector (Somdyala, Bradshaw, Gelderblom, & Parkin, 2010). While private sector patients have access to information, social workers and support groups, those in the public sector face life-threatening waiting times and a lack of empathy by public sector staff, weighed down by patient numbers and a lack of resources (Pillay 2002; Bateman, 2011). A study previously conducted by the researchers highlighted cancer patients‟ perceptions and experiences of treatment as being one of the most prominent themes influencing patients‟ overall cancer experience (Venter, Venter, Botha, & Strydom, 2008). This, coupled with the fact that the majority of research studies previously conducted in South Africa generally focused on the biomedical aspects of cancer (Albrecht, 2009), make exploring patients and healthcare professionals‟ perceptions and experiences of cancer treatment in a South African context potentially valuable. The thesis consists of three sub-studies reported in three manuscripts. The aim of the first article was to provide a narrative literature review exploring cancer survivorship and management in the South African context by scrutinising research previously conducted on cancer treatment. The aim of the second and the third article was to explore patients and healthcare professionals‟ perceptions and experiences of cancer treatment in the private and public healthcare sectors in the Eastern Cape, South Africa. A 100 participants were purposively sampled from a government-funded hospital (n = 30 patients; n = 22 healthcare professionals) and a private treatment facility (n = 30 patients; 18 healthcare professionals). Data was collected by making use of both qualitative (self-report questionnaire consisting of open-ended questions; interviews) and quantitative (Needs Evaluation Questionnaire) measures. A qualitative content and statistical analysis was conducted. Findings indicate that despite the expressed need for treatment to move towards a more biopsychosocial approach, the majority of the healthcare professionals in the current study are still primarily following a biomedical approach. Findings also indicate that the majority of the difficulties and frustrations experienced could be seen as being contextual problems and were not necessarily related to cancer treatment per se. Poor availability of resources and the South African population‟s diverse characteristics were responsible for the majority of the difficulties reported. Differing cultural beliefs, language barriers, illiteracy and unemployment were al seen as negatively influencing the treatment process. This is consistent with Serin et al. (2004), who reported that there is a significant relationship between the systemic nature of medical issues and the social, material and psychological difficulties cancer patients‟ experience. The systemic nature of healthcare needs highlighted in the current study emphasises the necessity for cancer treatment in South Africa to employ a more biopsychosocial approach. True collaboration between healthcare professionals working towards a common goal should thus be considered as being the ideal. Considering the socioeconomic divide and resource discrepancy between the private and public healthcare sectors in South Africa, credence must be given to the allocation of resources in the public sector. If this incongruity is to be addressed, there would have to be cooperation at government level. Assistance with regard to the allocation of funds, as well as the meticulous monitoring of the distribution thereof, is needed. Funding should be used to increase human and technical resources, as well as for staff development. Equitable care for all cancer patients, regardless of their socioeconomic status, is the ideal. The following recommendations on how to improve overall cancer care, in both sectors, can also be made: existing treatment sites need to be updated and additional sites developed; continuous research needs to be conducted; funds need to be allocated towards the development of effective transport and translation services; cultural diversity should be taken into account when developing awareness campaigns and treatment plans; healthcare professionals need to adopt a holistic approach during which attention is given to communication, establishing rapport and patient participation; and lastly healthcare professionals should also be encouraged to pay attention to their own healthcare needs as well. / PhD (Psychology), North-West University, Potchefstroom Campus, 2014