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1.
Metas enferm ; 23(1): 25-32, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-189186

RESUMO

OBJETIVO: examinar las barreras comunicativas que tienen los profesionales sanitarios cuando se enfrentan a un efecto adverso. MÉTODO: estudio cualitativo de orientación fenomenológica, desarrollado en el Servicio de Urgencias del Hospital de Tortosa Virgen de la Cinta (Tarragona), entre octubre y diciembre de 2018. Muestreo por conveniencia. Se llevaron a cabo dos grupos focales formados por seis-siete profesionales sanitarios que se agrupan en función del tiempo de experiencia profesional (mayor o menor a tres años). Los candidatos a participar se diferencian por edad, sexo y categoría profesional. Se usa el programa Atlas.Ti para el análisis. Se identifican tres categorías analíticas y 14 subcategorías. RESULTADOS: participaron 13 profesionales en dos grupos focales. Categorías que emergen del discurso: definición de efecto adverso, información y mejoras. Se normaliza la frecuencia de los errores. Hablan de errores leves y graves, diferenciando su actuación y los sentimientos. Refieren que parte de su aprendizaje es debido al ensayo-error de la práctica. Expresan miedo a informar en situaciones de gravedad. Hay una infrautilización del sistema de registro. Coinciden en dar la información en equipo, previo consenso, y expresan desprotección institucional. Proponen la implantación de los debriefings, identificación positiva, comunicación entre servicios, informatización y un cambio de turno estructurado. CONCLUSIÓN: el miedo a las respuestas, la pérdida de reputación y la falta de apoyo institucional aparecen como las principales barreras a la hora de admitir y comunicar los incidentes. Hay un amplio consenso sobre la falta de responsabilidad en la comunicación y disculpa de los eventos adversos y sobre la necesidad de aportar soporte y formación a los profesionales


OBJECTIVE: to review the communication barriers in healthcare professionals when faced with an adverse event. METHOD: a qualitative phenomenological study conducted at the Emergency Unit from the Hospital de Tortosa Virgen de la Cinta (Tarragona) between October and December, 2018, through convenience sampling. Two focus groups were set up, with six-seven healthcare professionals grouped by time of professional experience (over or below three years). The participants were differentiated by age, gender and professional category. The Atlas.Ti program was used for analysis. Three analytical categories and 14 subcategories were identified. RESULTS: the study included 13 professionals in two focus groups. The categories emerging from their speech were: definition of adverse event, information and improvements. The frequency of errors was normalized. They mentioned mild and severe mistakes, differentiating their action and feelings. They reported that part of their learning consists in trial-error during practice. They expressed fear to report in severe situations. The recording system is underused. They coincided in reporting as a team, after consensus, and they expressed lack of institutional protection. They proposed implementing debriefings, positive identification, communication between hospital units, information technologies, and a structured change of shift. CONCLUSION: fear of answers, loss of reputation, and lack of institutional support appeared as the main barriers at the time of acknowledging and reporting incidents. There was wide consensus about lack of responsibiility in communication and excuse for adverse events, and about the need to provide support and training to professionals


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Barreiras de Comunicação , Comunicação Interdisciplinar , Erros Médicos , Revelação/ética , Serviços Médicos de Emergência/ética , Serviços Médicos de Emergência/estatística & dados numéricos , Denúncia de Irregularidades/ética , Pesquisa Qualitativa , Segurança do Paciente , Grupos Focais
2.
Nurs Sci Q ; 32(4): 266-270, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31514621

RESUMO

In this article, the author describes two differing perspectives on paradox: the humanbecoming paradigm perspective and the management/organizational theory perspective. Examples of paradoxes from these two differing views are presented.


Assuntos
Modelos Organizacionais , Teoria de Enfermagem , Humanismo , Humanos , Lealdade ao Trabalho , Denúncia de Irregularidades/ética
6.
Nurs Ethics ; 26(4): 1039-1049, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29137552

RESUMO

BACKGROUND: After their attempts to have patient safety concerns addressed internally were ignored by wilfully blind managers, nurses from Bundaberg Base Hospital and Macarthur Health Service felt compelled to 'blow the whistle'. Wilful blindness is the human desire to prefer ignorance to knowledge; the responsibility to be informed is shirked. OBJECTIVE: To provide an account of instances of wilful blindness identified in two high-profile cases of nurse whistleblowing in Australia. RESEARCH DESIGN: Critical case study methodology using Fay's Critical Social Theory to examine, analyse and interpret existing data generated by the Commissions of Inquiry held into Bundaberg Base Hospital and Macarthur Health Service patient safety breaches. All data was publicly available and assessed according to the requirements of unobtrusive research methods and secondary data analysis. ETHICAL CONSIDERATIONS: Data collection for the case studies relied entirely on publicly available documentary sources recounting and detailing past events. FINDINGS: Data from both cases reveal managers demonstrating wilful blindness towards patient safety concerns. Concerns were unaddressed; nurses, instead, experienced retaliatory responses leading to a 'social crisis' in the organisation and to whistleblowing. CONCLUSION: Managers tasked with clinical governance must be aware of mechanisms with the potential to blind them. The human tendency to favour positive news and avoid conflict is powerful. Understanding wilful blindness can assist managers' awareness of the competing emotions occurring in response to ethical challenges, such as whistleblowing.


Assuntos
Atitude do Pessoal de Saúde , Governança Clínica/normas , Denúncia de Irregularidades/ética , Denúncia de Irregularidades/psicologia , Austrália , Governança Clínica/tendências , Ética em Enfermagem , Humanos , Segurança do Paciente/normas
7.
Nurs Ethics ; 26(2): 526-540, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28494645

RESUMO

BACKGROUND:: Whistle-blowing is an ethical activity that tries to end wrongdoing. Wrongdoing in healthcare varies from inappropriate behaviour to illegal action. Whistle-blowing can have negative consequences for the whistle-blower, often in the form of bullying or retribution. Despite the wrongdoing and negative tone of whistle-blowing, there is limited literature exploring them in healthcare. OBJECTIVE:: The aim was to describe possible wrongdoing in Finnish healthcare and to examine whistle-blowing processes described on the basis of the existing literature in healthcare as perceived by healthcare professionals. RESEARCH DESIGN:: The study was a cross-sectional descriptive survey. The data were collected using the electronic questionnaire Whistle-blowing in Health Care and analysed statistically. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 397 Finnish healthcare professionals participated, 278 of whom had either suspected or observed wrongdoing in healthcare, which established the data for this article. ETHICAL CONSIDERATIONS:: Ethical approval was obtained from the Ethics Committee of the University (20/2015). Permission to conduct the study was received according to the organisation's policies. FINDINGS:: Wrongdoing occurs in healthcare, as 96% of the participants had suspected and 94% had observed wrongdoing. Regarding the frequency, wrongdoing was suspected (57%) and observed (52%) more than once a month. Organisation-related wrongdoing was the most common type of wrongdoing (suspected 70%, observed 66%). In total, two whistle-blowing processes were confirmed in healthcare: (1) from suspicion to consequences occurred to 27%, and (2) from observation to consequences occurred to 37% of the participants. DISCUSSION AND CONCLUSION:: Wrongdoing occurs in healthcare quite frequently. Whistle-blowing processes were described based on the existing literature, but two separate processes were confirmed by the empirical data. More research is needed on wrongdoing and whistle-blowing on it in healthcare.


Assuntos
Assistência à Saúde/métodos , Denúncia de Irregularidades/ética , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Estudos Transversais , Assistência à Saúde/ética , Assistência à Saúde/normas , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos em Cuidados de Saúde/ética , Avaliação de Processos em Cuidados de Saúde/normas , Inquéritos e Questionários
8.
J Perinat Neonatal Nurs ; 32(1): 59-65, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29373419

RESUMO

Despite whistle-blower protection legislation and healthcare codes of conduct, retaliation against nurses who report misconduct is common, as are outcomes of sadness, anxiety, and a pervasive loss of sense of worth in the whistle-blower. Literature in the field of institutional betrayal and intimate partner violence describes processes of abuse strikingly similar to those experienced by whistle-blowers. The literature supports the argument that although whistle-blowers suffer reprisals, they are traumatized by the emotional manipulation many employers routinely use to discredit and punish employees who report misconduct. "Whistle-blower gaslighting" creates a situation where the whistle-blower doubts her perceptions, competence, and mental state. These outcomes are accomplished when the institution enables reprisals, explains them away, and then pronounces that the whistle-blower is irrationally overreacting to normal everyday interactions. Over time, these strategies trap the whistle-blower in a maze of enforced helplessness. Ways to avoid being a victim of whistle-blower gaslighting, and possible sources of support for victims of whistle-blower gaslighting are provided.


Assuntos
Má Conduta Profissional , Denúncia de Irregularidades , Ética Institucional , Humanos , Psicologia , Fatores Sociológicos , Denúncia de Irregularidades/ética , Denúncia de Irregularidades/legislação & jurisprudência , Denúncia de Irregularidades/psicologia
10.
BMJ Open ; 6(12): e011988, 2016 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-27993902

RESUMO

OBJECTIVE: To explore the views and experiences of health sector professionals in Australia regarding a new national law requiring treating practitioners to report impaired health practitioners whose impairments came to their attention in the course of providing treatment. METHOD: We conducted a thematic analysis of in-depth, semistructured interviews with 18 health practitioners and 4 medicolegal advisors from Australia's 6 states, each of whom had experience with applying the new mandatory reporting law in practice. RESULTS: Interviewees perceived the introduction of a mandatory reporting law as a response to failures of the profession to adequately protect the public from impaired practitioners. Mandatory reporting of impaired practitioners was reported to have several benefits: it provides treating practitioners with a 'lever' to influence behaviour, offers protections to those who make reports and underscores the duty to protect the public from harm. However, many viewed it as a blunt instrument that did not sufficiently take account of the realities of clinical practice. In deciding whether or not to make a report, interviewees reported exercising clinical discretion, and being influenced by three competing considerations: protection of the public, confidentiality of patient information and loyalty to their profession. CONCLUSIONS: Competing ethical considerations limit the willingness of Australian health practitioners to report impaired practitioner-patients under a mandatory reporting law. Improved understanding and implementation of the law may bolster the public protection offered by mandatory reports, reduce the need to breach practitioner-patient confidentiality and help align the law with the loyalty that practitioners feel to support, rather than punish, their impaired colleagues.


Assuntos
Tomada de Decisão Clínica/ética , Notificação de Abuso/ética , Segurança do Paciente/legislação & jurisprudência , Inabilitação do Médico/legislação & jurisprudência , Denúncia de Irregularidades/legislação & jurisprudência , Atitude do Pessoal de Saúde , Austrália , Feminino , Humanos , Relações Interprofissionais , Entrevistas como Assunto , Masculino , Inabilitação do Médico/psicologia , Pesquisa Qualitativa , Denúncia de Irregularidades/ética
18.
Med Humanit ; 41(2): 95-101, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25948788

RESUMO

'Thinking with Homer', or drawing creatively on themes and scenes from Homer's Iliad and Odyssey, can help us to better understand medical culture and practice. One current, pressing, issue is the role of the whistleblower, who recognises and exposes perceived poor practice or ethical transgressions that compromise patient care and safety. Once, whistleblowers were ostracised where medical culture closed ranks. However, in a new era of public accountability, medicine looks to formally embrace whistleblowing to the point that not reporting transgressions can now constitute a transgression of professionalism. Where medical students identify with the history and traditions of medical culture, they inevitably find themselves in situations of conflicting loyalties if they encounter senior clinicians behaving unprofessionally. What are the implications of facing these dilemmas for students in terms of role modelling and shaping of character as a doctor, and how might a study of Homer help with such dilemmas? We suggest that a close reading of an opening scene in Homer's the Iliad can help us to better appreciate such ethical dilemmas. We link this with the early Greek tradition of parrhesia or 'truth telling', where frankly speaking out against perceived injustice is encouraged as resistance to power and inappropriate use of authority. We encourage medical educators to openly discuss perceived ethical dilemmas with medical students, and medicine as a culture to examine its conscience in a transition from an authoritarian to an 'open' society, where whistleblowing becomes as acceptable and necessary as good hygiene on the wards.


Assuntos
Bullying , Educação Médica/tendências , Pessoas Famosas , Mundo Grego , Medicina na Literatura , Obrigações Morais , Médicos/normas , Responsabilidade Social , Estudantes de Medicina , Revelação da Verdade/ética , Virtudes , Denúncia de Irregularidades , Dissidências e Disputas , Educação Médica/normas , Mundo Grego/história , História do Século XXI , História Antiga , Humanos , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/tendências , Cultura Organizacional , Equipe de Assistência ao Paciente , Segurança do Paciente , Médicos/história , Médicos/psicologia , Identificação Social , Estudantes de Medicina/psicologia , Reino Unido , Denúncia de Irregularidades/ética , Denúncia de Irregularidades/legislação & jurisprudência , Denúncia de Irregularidades/psicologia
19.
Nurs Stand ; 29(28): 28, 2015 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-25758502

RESUMO

Medication errors are the second most reported incident type in the NHS. Other concerns around medicines management include poor medicines security, theft and poor administration practice.


Assuntos
Erros de Medicação/prevenção & controle , Gestão de Riscos , Humanos , Erros de Medicação/tendências , Enfermeiras e Enfermeiros/normas , Reino Unido , Denúncia de Irregularidades/ética
20.
J Trauma Dissociation ; 16(2): 139-52, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25602131

RESUMO

Research shows that many organizations overlook needs and opportunities to strengthen ethics. Barriers can make it hard to see the need for stronger ethics and even harder to take effective action. These barriers include the organization's misleading use of language, misuse of an ethics code, culture of silence, strategies of justification, institutional betrayal, and ethical fallacies. Ethics placebos tend to take the place of steps to see, solve, and prevent problems. This article reviews relevant research and specific steps that create change.


Assuntos
Organizações/ética , Códigos de Ética , Humanos , Princípios Morais , Cultura Organizacional , Inovação Organizacional , Denúncia de Irregularidades/ética
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