Fear Of Complaints Research Articles

Patients with borderline personality disorder and the effects of compulsory admissions on self-harm behaviour: a questionnaire study

Background Previous research on patients with borderline personality disorder (BPD) has indicated negative effects, including increased suicidality, from long hospital admissions and paternalism. Still, long-term compulsory admissions have been reported to occur regularly. Less is known about how healthcare personnel perceives these admissions and to what extent they think the use of compulsory care can be diminished. This study addresses those questions to make care more beneficial. Methods A questionnaire study, the respondents being nurses and psychiatric aides employed at psychiatric hospital wards in Sweden. The questionnaire contained questions with fixed answers and room for comments. 422 questionnaires were distributed to 21 wards across Sweden, and the response rate was 66%. The data were analysed with descriptive statistics and qualitative descriptive content analysis. Results Most respondents experienced that more than a week’s compulsory admission either increased (68%) or had no effect (26%) on self-harm behaviour. A majority (69%) considered the compulsory admissions to be too long at their wards, with detrimental effects on the patients. They also recognized several reasons for compulsory admissions without medical indication, like doctors’ fear of complaints and patients’ lack of housing. Also, patients sometimes demand compulsory care. Respondents recommended goal-oriented care planning, around three-day-long voluntary admissions, and better outpatient care to reduce compulsory hospital admissions. Discussion These findings imply that many BPD patients are regularly forced to receive psychiatric care that inadvertently can make them self-harm more. The respondents’ comments can be used as a source when formulating clinical guidelines.

A qualitative exploration of the views of paramedics regarding the identification of cardiovascular risk factors in the pre-hospital environment.

Cardiovascular disease remains the most prominent cause of death in England. Healthcare professionals have been encouraged to identify cardiovascular risk factors (CVRFs). The aim of this study was to explore how paramedics contribute to the identification of CVRFs in the pre-hospital setting, through their role, behaviours and practice. The study took place within the North East Ambulance Service NHS Foundation Trust supported by a National Institute for Health Research clinical research internship. A qualitative approach was used, and a single focus group was conducted. The study recruited participants through advertising for volunteers and purposive sampling. The themes that arose from the focus group allowed the initial exploration of the views of paramedics in relation to role, behaviour and practice in identifying CVRFs. A single focus group with five paramedics was conducted in June 2021. Two central themes emerged: education/health promotion and fear/anxiety. Participants agreed that their role in this area centred around patient education. Participants' behaviours and practice were adversely affected through fear of complaints, fear of hypocrisy and feeling a lack of support from the ambulance service. Participants felt that further training and subsequent indemnity from complaints would improve the likelihood of more direct patient education. Support from the ambulance service to improve employees' own health and well-being was also a key topic of discussion. The study explored the views of a small sample of paramedics on this topic. Patient education was felt to be part of a paramedic's role; however, barriers were identified that prevent paramedics from carrying out this role. Further research is needed to explore these barriers further.

Hospital staff at most psychiatric clinics in Stockholm experience that patients who self-harm have too long hospital stays, with ensuing detrimental effects

Background Previous research on patients who self-harm has indicated potential negative effects from long hospital stays. Yet, such care has been reported to occur regularly. We conducted this questionnaire study to investigate how hospital staff, who treat self-harming patients, experience the relation between lengths of stay and self-harm behaviour, and the motives for non-beneficial hospital stays. Methods The respondents of the questionnaire were nurses and mental health workers employed at public inpatient wards in Stockholm, treating patients who self-harm. The questionnaire contained questions with fixed answers and room for comments. A total of 304 questionnaires were distributed to 13 wards at five clinics, and the response rate was 63%. The data were analysed with descriptive statistics and qualitative descriptive content analysis. Results The results show that most staff experienced that more than a week’s stay either increased (57%) or had no effect (33%) on self-harm behaviour. Most respondents at most clinics considered the stays to be too long at their wards, and that the stays could be reduced. The respondents recognized several reasons for non-beneficial hospital stays, like fear of suicidal behaviour and doctors’ fear of complaints. Patients appearing as demanding or fragile were thought to be given more care than others. The respondents’ comments confirmed the majority’s experience of detrimental effects from longer hospital stays. Conclusions A majority of the health care staff experienced that patients who self-harm often receive too long hospital stays, with detrimental effects, and they had experienced several non-medical reasons for such care.

Stress and Stress Management in Health Institutions

The purpose of this research was to determine main stress factors that health workers face with and ways of coping with this stress. To this end, data were obtained by face to face questionnaire from 103 health care workers employed in Merzifon Asker Hastanesi. These data were analyzed with SPSS 16.0 package program. At the end of the study, 83% of the participants stated that they have various stress factors. İn the studied sample, disvaluation of work by others, inequitable distribution of tasks, common workplace gossip, relations with managers, injustice in performance evaluation as well as patient dissatisfaction and fear of complaints were found as leading stress factors. When methods for coping with stress were questioned, most common answers were; ‘I repress’, ‘I fret’, ‘I try to solve by myself, and 21will share with my close friends and my family2. İt was found that stress factors and coping methods differ based on occupation, sex, and business life time. Considering that services in health sector should be carried out with the least error possible, its obvious that personnel satisfaction has a key role. Therefore, there is an urgent need for effective studies about individual and corporate stress management are needed in our health corporation for the reduction of stress factors.

Obstetricians' Choice of Cesarean Delivery in Ambiguous Cases: Is It Influenced by Risk Attitude or Fear of Complaints and Litigation?

Obstetricians' Choice of Cesarean Delivery in Ambiguous Cases: Is It Influenced by Risk Attitude or Fear of Complaints and Litigation?

Obstetricians' choice of cesarean delivery in ambiguous cases: is it influenced by risk attitude or fear of complaints and litigation?

The aim of this study was to test the hypothesis that obstetricians' choice of delivery method is influenced by their risk attitude and perceived risk of complaints and malpractice litigation. The choice of delivery method in ambiguous cases was studied in a nationwide survey of Norwegian obstetricians (n = 716; response rate, 71%) using clinical scenarios. The risk attitude was measured by 6 items from the Jackson Personality Inventory-Revised. The proportion of obstetricians consenting to the cesarean request varied both within and across the scenarios. The perceived risk of complaints and malpractice litigation was a clear determinant of obstetricians' choice of cesarean in all of the clinical scenarios, whereas no impact was observed for risk attitude. Obstetricians' judgments about cesarean request in ambiguous clinical cases vary considerably. Perceived risk of complaints and litigation is associated with compliance with the requested cesarean.

Job Stress in Young Physicians with an Emphasis on the Work-Home Interface: A Nine-Year, Nationwide and Longitudinal Study of its Course and Predictors

Although physicians are known to experience more stress than other workers, knowledge is lacking on the course of stress from a longitudinal perspective. This study explored the course of and contributors to, different dimensions of early career job-stress among physicians by means of a nationwide mail survey, with a particular emphasis on stress relating to the work-home interference. All physicians graduating from all four Norwegian universities in 1993 / 94 (N=631), responded during their final year of medical school (N=522), during their internship (N=402), in their 4th postgraduate year (N=422), and in their 10th postgraduate year (N=390). The mean observation period was 9.2 yr (SD=0.5). The main outcomes were job stress dimensions derived from an established job stress questionnaire (Cooper / Tyssen), with emphasis placed on dimensions of the work-home interference. Stress relating to the work-home interference increased during the observation period for both genders (repeated measures: beta=0.06, p<0.05), whereas stress relating to emotional pressure, time pressure, and fear of complaints and criticism, decreased. Stress relating to the work-home interference increased during their early career, mainly due to a lack of adaptive reduction in work hours and an increased number of children. Neuroticism, conscientiousness, and lack of support from one's partner and colleagues, appeared to be predictive of this stress.

The use of patients for learning and maintaining practical skills

Throughout their careers, doctors have an ethical obligation to consider the benefits and harms of treatment, and choose the most appropriate for each patient, resources allowing. There is also a legal requirement to practise to acceptable standards together with a professional requirement to participate in continuous medical education/professional development. The General Medical Council (GMC) states 'Doctors are responsible for maintaining their professional competence and standard of performance...'1 and 'You must keep your knowledge and skills up to date... '2. There is a corresponding duty to educate others: 'You should be willing to contribute to the education of students or colleagues.'2 A doctor's prime duty, however, is to 'Make the care of your patient your first concern'2—a duty that sits awkwardly with the other duty to learn and maintain less familiar skills that might be required for other patients. This conflict has implications for respecting patients' autonomy, gaining consent for treatments and upholding standards of practice. For example, fear of complaint or legal action motivates many anaesthetists specifically interested in airway management to stop teaching others on procedures or maintaining their own skills (debate and discussion, Difficult Airway Society Annual Meetings, Edinburgh 1999 and London 2002), despite recognized deficiencies in these skills.3 Most of their concerns relate to informed consent for specific procedures or parts thereof—even though many consider them 'routine'. Such concerns may not be unwarranted: there are discrepancies between what patients would wish to be informed about and what anaesthetists feel they should be informed about.4 The published work tends to neglect this dilemma, instead focusing on junior trainees, medical students, or practice on the recently dead,5-7 but it merits wide debate especially at a time when specialist training is being curtailed and new consultants will be short of practical experience.8,9 Here I discuss the following questions. What is a 'procedure' and how can one decide whether its components can or should be considered separately—for example, regarding consent and choice? How can doctors balance their obligations to the present patient with those to future patients and society? Do patients themselves have obligations to other patients such that they ought to participate in doctors' learning or maintenance of skills? And how can the practitioner reconcile these conflicts while respecting patients' autonomy? Finally, I offer a stepwise, practical approach based on consideration of these questions.

Sources and implications of dissatisfaction among new GPs in the inner-city.

We aimed to examine the factors that were most stressful for new principals in inner-city general practice. In addition, given the concerns about retention of new principals, to ascertain whether high perceived stress translated into regret that they had joined their practice and factors that might protect from regret. A questionnaire survey, within an inner-city Health Authority. The subjects were 101 GPs appointed as principals between 1992 and 1995. Eighty-three out of 101 GPs replied. The greatest sources of stress were, in order, patient expectations, fear of complaint, out-of-hours stress and fear of violence. Although these stresses were scored highly, 61% expressed no regret at having joined their practice with just 4% reporting considerable regret. Stress within the partnership and stress arising from patient expectations accounted for 23% of the variation in regret. Holders of the MRCGP were significantly protected against regret; there was no evidence that other factors such as medical positions outside the practice, membership of a young principals support group, fundholding status or training practices offered significant protection against regret. Despite reported difficulties in recruiting new young principals to the inner-city-and despite their reported high levels of stress-few have regrets about their decision to join their practice. For those who did regret joining their practice, the three principal associations were partnership stress, patient expectations and not possessing the MRCGP. Each of these factors may be amenable to intervention by policies geared to improve GP retention.