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Aims: This article aimed to examine the concept of safeguarding adults and establish an operational definition for application to practice, research and policy. Design: Rodgers' evolutionary and inductive method of concept analysis was used. Data Sources: A systematic search was conducted across four electronic databases, CINAHL, PsycINFO, Scopus and PubMed, covering the period from January 2014 to May 2023. This systematic database search aimed to gather a broad spectrum of research and scholarly literature to inform and support the concept analysis. A total of 10 peer‐reviewed articles were reviewed using a data chart to identify the context, definitions, antecedents, attributes and consequences of safeguarding adults. Results: The analysis of the included articles helped to develop a better understanding of safeguarding adults by offering a practical operational definition tailored to the specific needs of practising nurses. The implications for practice, research and policy are discussed, highlighting the potential for improving the quality of care and ensuring the well‐being of adults at risk of abuse. Conclusion: By employing Rogers' evolutionary concept analysis method, we developed a deeper insight into safeguarding adults in health care. A synthesis of literature revealed the intricate layers and adaptations within safeguarding practices. This concept analysis lays the groundwork for future research, policy development and educational initiatives, enhancing the well‐being and safety of adults at risk of abuse within care. Impact: By undertaking a concept analysis of the term safeguarding adults' nurses can be more prepared to engage in and reinforce the key principles of safeguarding adults, providing guidance to ensure the protection and well‐being of adults at risk of abuse. Patient or Public Contribution: Not applicable. What this Paper Contributes to the Wider Body of Knowledge: This concept analysis helps to define and clarify the conceptual term 'safeguarding adults' promoting a shared understanding of the key components of adult protection and providing a comprehensive framework for assessment and management of adults at risk of abuse in this field of practice. [ABSTRACT FROM AUTHOR]

Background: People with severe learning disabilities and complex needs are more likely to experience delayed discharge from hospital; however, there is little research into their experience in hospital and as they move out as part of the Transforming Care Programme. Methods: Six family members of people with complex needs who had moved out of hospital took part in four focus groups co‐facilitated with an expert‐by‐experience consultant. Participants' relatives had hospital admissions that ranged from 6 weeks to 11 years. Transcripts were analysed using reflexive thematic analysis. Additional reflections are included from an expert‐by‐experience consultant to capture their unique perspective. Results: Family members reported stories of abuse in hospital and parallel experiences of institutionalisation and trauma, resulting in long‐lasting impacts on themselves and their relative. Family members felt let down and undervalued by professionals. They described relief when their relatives moved out of hospital, but there were on‐going difficulties accessing the right support in the community and so stability felt fragile. Conclusions: Key recommendations to support community living include respecting family members' expertise, improving partnership working and offering psychological support for family members and people with complex needs post‐discharge. Accessible Summaries: We wanted to understand the experiences of families of people with complex needs living in a mental health hospital and moving out of hospital.Family members talked about how difficult the experience of being in hospital had been for their relative and for themselves.Family members felt very unsupported and let down by professionals.Family members talked about feeling relieved that their relative had moved out of hospital.There had been lots of on‐going problems accessing the right support for their relative.Family members and their relatives need specialist support to help the person with complex needs to live in the community and out of hospital. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to study themes of abuse and mistreatment of people with a learning disability. Personal stories of lived experience such as this are important pieces of learning and information for practitioners. This case study is intended to add to the limited available knowledge base of lived experience, offering insight into safeguarding in practice. Design/methodology/approach: This is a single case study highlighting lived experiences written by and from the perspective of a sibling of a person with a learning disability who has experienced abuse in the social-care system. Findings: Structural ongoing abuse occurs and has occurred in the social care system. How we respond to this as a system and societally is a multi-layered challenge that underpins the ability to ensure the safety and well-being of the most vulnerable peers. Originality/value: Case studies such as this are limited, with underpinning themes that are all too common. The case study adds to literature that gives insight and perspective into experiences of systems, and of systemic failures to act. [ABSTRACT FROM AUTHOR]

The Life Esidimeni tragedy stands as a critical case of healthcare governance failure in South Africa, resulting in the deaths of 141 mental healthcare patients and the severe mistreatment of over 1,400 others. In 2015, the Gauteng Department of Health (GDOH) terminated its contract with Life Esidimeni, a specialized psychiatric facility, as part of a cost-driven deinstitutionalization policy. Patients were rapidly transferred to unlicensed non-governmental organizations (NGOs) that lacked the necessary resources and capacity, leading to widespread neglect, abuse, and preventable deaths. This study examines the governance breakdowns, ethical lapses, and decision-making failures that permitted this tragedy, drawing on government reports, judicial inquiries, and expert testimonies. The findings highlight the consequences of prioritizing cost-cutting over patient welfare and reveal significant gaps in oversight, accountability, and stakeholder engagement within the GDOH. By examining Life Esidimeni alongside global cases of mental healthcare reform, this study demonstrates the universal need for ethical governance structures, effective oversight mechanisms, and protections for the rights of vulnerable populations in healthcare settings. The discussion provides actionable recommendations for policymakers, advocating for regulatory frameworks that prioritize patient welfare, require rigorous oversight, and mandate inclusive decision-making processes. This analysis offers lessons for healthcare systems worldwide, urging reforms that place patient rights and ethical governance at the forefront to prevent similar crises. [ABSTRACT FROM AUTHOR]

The verbal abuse research in social services is limited. This study aimed to describe verbal abuse of service users by professionals in social services. This cross-sectional descriptive study examined statutory reports of threats or risks in implementing social services in one city of Finland, from 2016 to 2020 (n = 1433). The case reports describing the verbal abuse (n = 34) were analysed using inductive content analysis. The perpetrators were registered and unregistered professionals. The types of abuse included inappropriate speaking style, oppression or dominance, and sometimes verbal abuse was accompanied by physical violence or threats of violence. The consequences affected the emotional well-being of service users, the fulfilment of their needs and the delivery of services. Actions implemented as a result of the reports consisted of monitoring, supporting, educating and alerting professionals about verbal abuse and raising awareness about the reporting. The findings suggest proactive training for professionals on behavioural boundaries and whistleblowing. [ABSTRACT FROM AUTHOR]

Background. Respectful maternity care (RMC) is a crucial approach to enhancing the experiences of mothers. This study aimed to explore women's views on the factors contributing to disrespect and abuse (D&A) during childbirth. Methods. A qualitative study was conducted with 12 postpartum women selected through purposive sampling to ensure maximum diversity. Data were gathered through in-depth semi-structured interviews and analyzed using a conventional content analysis method. Results. The analysis revealed seven key categories. These categories included respect for women, meeting needs and preferences, involvement of women, continuity of care, empathy, adequate human and non-human resources, and factors that deter D&A. Conclusion. It is essential to develop effective interventions to enhance RMC across various dimensions. Providing RMC during and after childbirth necessitates the involvement of policymakers and health managers. This can be accomplished by addressing the welfare and environmental needs, showing empathy towards mothers, safeguarding their privacy, alleviating staff workloads, and transforming the attitudes of healthcare workers. [ABSTRACT FROM AUTHOR]

Globally, significant numbers of women report obstetric violence (OV) during childbirth. The United Nations has identified OV as gendered violence. OV can be perpetrated by any healthcare professional (HCP) and is impacted by systemic issues such as HCP education, staffing ratios, and lack of access to continuity of care. The current study explored the experiences of OV reported in a national survey in 2021 by Australian women who had a baby in the previous 5 years. A content analysis of 626 open text comments found three main categories: "I felt dehumanised," "I felt violated," and "I felt powerless." Women reported bullying, coercion, non-empathic care, and physical and sexual assault. Disrespect and abuse and non-consented vaginal examinations were the subcategories with the most comments. [ABSTRACT FROM AUTHOR]

Despite the extant research on work and well-being in the healthcare sector, a comprehensive overview of the key work characteristics, and a meta-analytic investigation of their over-time relationships with well-being, are still lacking. This study provides (1) a summary of the most investigated job demands and resources at the group, leadership, and organisation levels (GLO) explored in the European healthcare sector; (2) a quantitative analysis of their prospective association with well-being; (3) a test of the moderator effect of work characteristics' source (GLO) and time lag. A systematic literature search was completed resulting in 47 independent samples (N = 39,467 healthcare employees). We identified a wide range of challenge (i.e. workload), hindrance (i.e. role stress), threat demands (i.e. violence from patients) and resources (i.e. control, support). Meta-analytic results showed that hindrance and threat demands were more detrimental than challenge demands, but unexpectedly challenge demands were not related to motivational outcomes. Baseline resources had an important role in protecting and promoting follow-up employee well-being, with group-level resources being more strongly negatively associated with strain. We found no significant differences in well-being between GLO levels of job demands. Time lag did not significantly moderate the prospective associations among work characteristics and employee well-being. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To better understand the areas of risk that may become apparent across the life course of dementia • To recognise the ethical issues posed by trying to eliminate the risk of harm for people living with dementia • To consider how the principles of safeguarding apply to risk management in dementia care. What constitutes a risk for a person living with dementia may be perceived and prioritised differently by nurses from varying clinical backgrounds. Furthermore, risk may be perceived differently according to the context. This article outlines some of the social, psychological and physical risk factors relevant to people living with dementia across the life course of the condition. It is important that nurses understand their role in identifying, assessing and managing risk and are aware of the resources, policies, legislation and processes designed to support decision-making and minimise the risk of harm to people living with dementia, their families and carers. The authors hope that this article will support nurses to become more confident in identifying risk while encouraging them to adopt a proactive and person-centred approach to risk assessment and management. [ABSTRACT FROM AUTHOR]

This Special Communication discusses the essential elements of designing and implementing informed consent practices for psychedelic medicine. Importance: Interest in administering psychedelic agents as mental health treatment is growing rapidly. As drugmakers invest in developing psychedelic medicines for several psychiatric indications, lawmakers are enacting legal reforms to speed access globally, and health agencies are preparing to approve these treatments. Meanwhile, US states, such as Oregon and Colorado, are making psychedelics available for supervised use outside the conventional health care system. Observations: Despite legal change and potentially imminent regulatory approval in some countries, standards for integrating psychedelics into health care have lagged, including norms for designing and implementing informed consent processes. Informed consent is complicated by the unique features of psychedelics and their means of administration. Because no governments have approved any classic psychedelics for general medical or psychiatric use, only clinical researchers have obtained informed consent from trial participants. Accordingly, there is an unmet need for informed consent processes tailored to the challenges of administering psychedelics in nonresearch settings. Conclusions and Relevance: Analysis of the challenges of designing and implementing psychedelic informed consent practices revealed 7 essential components, including the possibility of short- and long-term perceptual disturbances, potential personality changes and altered metaphysical beliefs, the limited role of reassuring physical touch, the potential for patient abuse or coercion, the role and risks of data collection, relevant practitioner disclosures, and interactive patient education and comprehension assessment. Because publicly available informed consent documents for psychedelic clinical trials often overlook or underemphasize these essential elements, sample language and procedures to fill the gap are proposed. [ABSTRACT FROM AUTHOR]

Background: Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). Methods: An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. Results: The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating). Conclusions: This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges. Plain English summary: Evidence suggests that mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In this qualitative study, through 30 in-depth interviews with key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals), we identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). The data were analyzed using directed content analysis and a deductive approach in MAXQDA 18 software. The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability; presence of birth companions: e.g., patient needs and resources); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief childbirth guidelines: e.g., networks and communications). This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth; and highlights potential implications for policy makers and practitioners of maternal health programs. [ABSTRACT FROM AUTHOR]

The article discusses the responsibility of ethicists to report significant ethical violations by physicians to state medical boards, including instances of patient abuse or unnecessary procedures. It highlights the need for consistent practices and suggests that while state medical boards can revoke licenses, disciplinary actions vary. It emphasizes ethicists can use reporting mechanisms within hospitals or communicate directly with hospital leadership to address such violations.

Abuse in health care (AHC) is an emerging concept used to describe healthcare practices and conduct that health services users find belittling and degrading. Such experiences, whose causes are not always voluntary but systematic and structural, have been described as one of the main barriers to the trans and non-binary population's access to health care. To study this problem in Chile, the country's first trans and non-binary health survey was conducted between January 2021 and June 2022 with the participation of 1116 people. Univariate statistical analyses were performed to calculate the frequencies (f) and percentages (%) of the different forms of AHC reported. Chi-squared tests (p < 0.01) and the Pearson correlation coefficients (r > 0.10) were used to identify statistically significant correlations between experiences of AHC, the health personnel reportedly involved, and participants' responses to these experiences. About 84% of the participants who replied to questions on this subject said that they had experienced some form of AHC. The most frequently reported were inappropriate use of pronouns (65.9%) and stereotypical comments about genders (48.3%). These events occurred mostly in encounters with secretaries and receptionists, followed by psychologists and nurses. The most frequent response of participants to these situations was to change the medical staff responsible for their care, followed by ceasing to seek professional attention. A mainstreamed relational gender perspective is required to address the complexity of this problem. [ABSTRACT FROM AUTHOR]

Home care is the preferred care option for most people who need support; yet abuse exists in these settings toward both home care workers and clients. There are no existing reviews that assess the scope of current research on abuse in home care, and tangentially related reviews are dated. For these reasons, a scoping review is warranted to map the current state of research on abuse in home care and examine current interventions in this field. Databases selected for searching were Medline and EMBASE on OVID, Scopus, and the following databases in EBSCOhost: Academic Search Complete, AgeLine, and Cumulative Index to Nursing and Allied Health Literature. Records were included if: (a) they were written in English; (b) the participants were home care workers or clients age 18 years or older; (c) they were published in journals; (d) they undertook empirical research; and (e) they were published within the last 10-year period. Following Graham et al. (2006), the 52 included articles are categorized as either knowledge inquiry or as intervention studies. We find three themes among knowledge inquiry studies: (1) prevalence and types of abuse in home care, (2) abuse in the context of living with dementia, and (3) working conditions and abuse. Analysis from the intervention studies suggest that not all organizations have specific policies and practices to prevent abuse, and no existing interventions to protect the well-being of clients were identified. Findings from this review can inform up-to-date practice and policymaking to improve the health and well-being of home care clients and workers. [ABSTRACT FROM AUTHOR]

Introduction: Stigma and bias related to race and other minoritized statuses may underlie disparities in pregnancy and birth outcomes. One emerging method to identify bias is the study of stigmatizing language in the electronic health record. The objective of our study was to develop automated natural language processing (NLP) methods to identify two types of stigmatizing language: marginalizing language and its complement, power/privilege language, accurately and automatically in labor and birth notes. Methods: We analyzed notes for all birthing people > 20 weeks' gestation admitted for labor and birth at two hospitals during 2017. We then employed text preprocessing techniques, specifically using TF-IDF values as inputs, and tested machine learning classification algorithms to identify stigmatizing and power/privilege language in clinical notes. The algorithms assessed included Decision Trees, Random Forest, and Support Vector Machines. Additionally, we applied a feature importance evaluation method (InfoGain) to discern words that are highly correlated with these language categories. Results: For marginalizing language, Decision Trees yielded the best classification with an F-score of 0.73. For power/privilege language, Support Vector Machines performed optimally, achieving an F-score of 0.91. These results demonstrate the effectiveness of the selected machine learning methods in classifying language categories in clinical notes. Conclusion: We identified well-performing machine learning methods to automatically detect stigmatizing language in clinical notes. To our knowledge, this is the first study to use NLP performance metrics to evaluate the performance of machine learning methods in discerning stigmatizing language. Future studies should delve deeper into refining and evaluating NLP methods, incorporating the latest algorithms rooted in deep learning. Significance: What is Already Known on this Subject?: Traditional informatics methods include natural language processing, and these methods have been increasingly applied to the study of public health problems using electronic health records. What this Study Adds?: We identified well-performing machine learning methods to automatically identify stigmatizing language in labor and birth clinical notes. These methods have not been applied to labor and birth clinical notes and have the potential to be a powerful tool in examining perinatal health inequities. [ABSTRACT FROM AUTHOR]

Aim: To use co‐design principles to design a nationwide maternity experiences survey and to distribute the survey through social media. Design: A co‐designed, cross sectional, and national online survey. Methods: Using co‐design principles from study design and throughout the research process a cross‐sectional, online, national survey of Australian women's experiences of maternity care was designed. Four validated survey instruments were included in the survey design. Results: An extensive social media strategy was utilized, which included paid advertising, resulting in 8804 surveys for analysis and 54,896 comments responding to open text questions. Discussion: The inclusion of co‐design principles contributed to a well‐designed survey and consumer involvement in distribution and support of the online survey. The social media distribution strategy contributed to high participation rates with overall low marketing costs. Clinical Relevance: Maternity services should be designed to provide woman‐centered, individualized care. This survey was co‐designed with maternity users and maternity organizations to explore women's recent experiences of maternity care in Australia. The outcomes of this study will highlight the factors that contribute to positive and negative experiences in maternity services. Patient or Public Contribution: As a co‐designed study, there was consumer engagement from the design of the study, throughout the research process. [ABSTRACT FROM AUTHOR]

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The article provides information on assessing and treating patients with borderline personality disorder (BPD), a cluster B personality disorder characterized by a high degree of impulsivity and marked instability in self-image, emotions, and interpersonal relationships. Topics include physical health outcomes in BPD, diagnostic criteria for BPD, and management of BPD in the general medical setting.

This study was conducted to determine the relationship between violence, risk factors, and depression at the end of pregnancy. The sample of this descriptive and cross-sectional study consisted of 426 women for normal postpartum monitoring during the six-month period and living in southwestern Turkey of the study. About 5.6% of the women who participated in the study were exposed to obstetric violence. 5.2% of them were intimate partner violence before pregnancy. 79.1% (n = 24), 29.1%, and 25% of them were subjected to physical, sexual, and economic violence, respectively. In addition, 7.5% of women were exposed to verbal obstetric violence. It was found that the postpartum depression scores of the women who had been subjected to violence from their husbands before pregnancy were high. [ABSTRACT FROM AUTHOR]

Background: Rights-based Respectful Maternity Care (RMC) is crucial for quality of care and improved birth outcomes, yet RMC measurements are rarely included in facility improvement initiatives. We aimed to (i) co-create a routine RMC measurement tool (RMC-T) for congested maternity units in Dar es Salaam, Tanzania, and (ii) assess the RMC-T's acceptability among women and healthcare stakeholders. Method: We employed a participatory approach utilizing multiple mixed methods. This included a scoping review, stakeholder engagement involving postnatal women, healthcare providers, health leadership, and global researchers through interviews, focus groups, and two surveys involving 201 and 838 postnatal women. Cronbach's alpha and factor analysis were conducted for validation using Stata 15. Theories of social practice and Thematic Framework of Acceptability guided the assessment of stakeholder priorities and tool acceptability. Results: The multi-phased iterative co-creation process produced the 25-question RMC-T that measures satisfaction, communication, mistreatment (including physical, verbal, and sexual abuse; neglect; discrimination; lack of privacy; unconsented care; post-birth clean-up; informal payments; and denial of care), supportive care (such as food intake and mobility), birth companionship, post-procedure pain relief, bed-sharing, and newborn respect. The pragmatic validation process prioritized stakeholder feedback over strict statistics, lowering Cronbach's alpha from 0.70 in version 1 to 0.57 for the RMC-T. Women valued the opportunity to share their experiences. Conclusions: The RMC-T is contextualized, validated, and acceptable for measuring women's experiences of RMC. Routine use in facility-based quality improvement initiatives, along with targeted actions to address gaps, will advance rights-based RMC. Further validation and community-based studies are needed. Paper Context: • Main findings: This study describes the participatory approach involving postnatal women, healthcare providers, health leadership, and global researchers to co-create and validate a tool for measuring women's experiences of respectful maternity care in Dar es Salaam's urban health facilities. • Added knowledge: The iterative process produced a concise, 25-item Respectful Maternity Care Measurement tool that is user-friendly, administered in 15–20 minutes and addresses all mistreatment domains. The tool reflects women's priorities and is well accepted by postnatal women and health leaders. • Global health impact for policy and action: Regular use of the tool can enhance awareness of childbirth rights and drive actions to improve and normalize respectful maternity care in low-resource urban settings. [ABSTRACT FROM AUTHOR]

In the United States, small residential care homes provide affordable community-based care for disabled older adults. Also called adult foster care homes, residential care facilities, group homes, or board and care homes, small residential care homes are typically private, small businesses operating in single-family dwellings that provide round-the-clock care in a home-like setting in residential neighborhoods. While most states license small residential care homes they also exist, legally and illegally, as unlicensed and unregulated operations. The quality of care in some unlicensed and unregulated small residential care homes can be questionable. Disabled older adults are targeted and victimized by unethical small residential care home operators for financial gain. This commentary highlights the need for whole system disruption to end victimization in unethical unlicensed and unregulated small residential care homes through case studies of the abuse and neglect of residents living in unethical unlicensed operations and recommends ambitious goals centered on reducing secondary financial gains and medically neglectful practices. These recommendations are at federal, state, and local levels, and include creating a federal definition of small residential care homes, increasing and coupling government incomes with state registration and employee misconduct registry checks, increasing oversight and assessment, improving temporary guardianship processes, providing avenues for reporting abuse, and developing older adult fatality review teams. [ABSTRACT FROM AUTHOR]

Objective: This study aims to translate, validate, and assess the reliability of the Turkish version of the Perception of Obstetric Violence in Students Questionnaire (PercOV-S Q) and describe disrespectful and abusive mistreatment during facility-based childbirth. Materials and Methods: The PercOV-S Q, an objective questionnaire measuring perceived mistreatment during facility-based childbirth, comprising 33 positively worded questions on a 5-level Likert scale, was translated into Turkish. An online survey was sent to 140 obstetrics and gynecology residents via hospital email accounts, with 133 participants forming the cohort. Principal component factor analysis with varimax rotation was performed, and items with a loading of 0.40 on a principal components analysis were retained. The Cronbach’s statistic was used to evaluate internal consistency, with a value of 0.70 indicating satisfactory internal consistency. Results: The main result of this study is the Turkish translation of the PercOV-S Q is valid and reliable. The viability of factor analysis was confirmed by the Kaiser-Meyer-Olkin (KMO) test (p = 0.814) and Bartlett’s test for sphericity (X2 = 1898.897; p ≤ 0.001). The overall reliability of the questionnaire, measured by Cronbach’s Alpha score, was 0.840, indicating the questionnaire is suitable at the individual level in Turkish. Conclusion: The lack of a precise definition makes it difficult to understand the real perception among healthcare professionals and limits educational opportunities against obstetric mistreatment. In conclusion, the PercOV-S Q serves as a comprehensive and universal tool, and the Turkish translation of this questionnaire can be used as educational material. Translating and validating the PercOV-S Q across various languages and administering it to trainees from different cultural backgrounds will highlight its universal applicability and improve insights into the worldwide occurrence of obstetric mistreatment. [ABSTRACT FROM AUTHOR]

Obstetric violence has started to attract attention as a form of violence against women. This study aimed to determine and analyze the psychometric properties of a Turkish version of the Obstetric Violence Questionnaire (OVQ). Four hundred sixty-eight women from 19 to 59 years of age (M = 35.28, SD = 7.22) participated. The confirmatory factor analysis confirmed a multifactorial structure of two factors. The Cronbach's α internal consistency coefficients were.72,.70, and.73 obtained for the total scale, abuse and violence, and non-consented care subscale, respectively. The OVQ consisted of 11 items, proving to be a reliable and brief measure. [ABSTRACT FROM AUTHOR]

BACKGROUND: Childbirth is a significant event with a great impact on maternal physical and psychological health. Childbirth abuse has been reported in different countries with variable rates. This study aims to determine the prevalence of childbirth abuse during labor in a governmental hospital in Egypt. METHODS: This cross-sectional study was conducted from March 2020 to December 2021. We recruited 190 women. Patients were asked to fill in the Arabic-validated childbirth verbal abuse and neglect questionnaire immediately after delivery. The questionnaire consisted of four parts enquiring about personal data and childbirth history, the occurrence of physical violence, and other elements of satisfaction. RESULTS: Fifty (26.3%) patients were neglected during childbirth. Verbal abuse was reported by 25.8%. Two women (1.1%) were slapped (physical abuse) during childbirth. Women reported being satisfied and strongly satisfied at 57.9% and 37.9%, respectively. Multiparity (p-value .02), patient ignorance about the childbirth process (p-value .004), their rights (p-value .0001), and lack of participation in decision-making (p-value .0001) were associated with exposure to neglect. Verbal abuse was associated with the delivery time in addition (p-value .004). CONCLUSION: Neglect and abuse occurred significantly at the current facility. [ABSTRACT FROM AUTHOR]

An editorial is presented that explores the complex dynamics of coercion in mental health treatment, particularly how power imbalances between clinicians and patients can influence perceptions of coercion. It critiques existing theories, highlighting the importance of contextual factors and the individual patient's background in shaping their understanding of treatment pressures.

Policy efforts addressing abuse of people with disability tend to focus on more extreme forms of violence, sometimes at the expense of attending to everyday indignities and insults experienced when receiving support. Recognition theory provides a lens for identifying actions and attitudes of misrecognition that can cause hurt, humiliation or degradation, and have a negative effect on identity formation. Honneth's concept of misrecognition is used to analyse qualitative data from 42 pairs of young people with intellectual disability and support workers. Many of the casual interactions that signalled misrecognition highlight the everyday harms that people receiving or giving support are exposed to in their paired relationship. Systems must respond to the high likelihood of these risks of misrecognition. Supervision, training, reflective practice and support activities can expose the problems and demonstrate practices more likely to positively impact the identity formation and wellbeing for both people with disability and support workers. Everyday harms are things that happen often in services which upset people, but which do not get treated as violence or abuse. They are things like having unkind jokes made about you, being ignored, or being disrespected. In our project, we called this misrecognition. We looked at when misrecognition happened between young people with disability and their paid support workers. A... lot of the time, people did not intend to cause harm. The other person was still hurt by the things they did or said. We can improve the way that people with disability and support workers work together if people understand how their actions affect other people. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to describe the alleged abuse of social care clients committed by nurses and other social services employees and actions as well as sanctions that followed the alleged abuse. Design: A retrospective study using a descriptive qualitative analysis. Methods: The data comprised mandatory reports made by social service employees under the Social Welfare Act. This study focused on the reported abuses of clients (n = 75) by social services employees from 11 October 2016 to 31 December 2020 in Finland. The data were analysed using inductive content analysis and quantification. Results: The majority of the reports were submitted practical nurses and other nursing personnel and by registered nurses. The severity of the abuse was most often mild or moderate. The most common abusers were nurses. The types of alleged abuse committed by professionals were as follows: (1) neglect of care, (2) physical violence/strong‐arm treatments, (3) neglect of hygiene, (4) inappropriate or threatening behaviour and (5) sexual abuse. The actions and sanctions that followed the alleged abuse were: (1) discussing the situation together, requesting an explanation, initiating hearing or defining developmental measures, (2) initiating disciplinary actions and providing verbal or written warnings, (3) dismissing or terminating the employee and (4) initiating a police investigation. Conclusion: Nurses are an important group working in social services and might also be involved in cases of abuse. Implications for the Profession and/or Patient Care: It is important that risks, wrongdoings and abuses are reported. Transparent reporting indicates strong professional ethics. Impact: Knowledge about abuse in social services from the viewpoint of nursing is important for ensuring the quality and safety of services. Reporting Method: The Standards for Reporting Qualitative Research guideline was followed. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Institutional betrayal has been used to describe the experiences of sexual assault survivors who are harmed by institutions which they rely on for safety or survival. This concept has primarily been studied in the context of survivors' direct relationships with institutions they are members of (e.g., universities, churches, military) and how the said institutions either failed to protect them or were unsupportive following their disclosure. Institutional betrayal can exacerbate negative mental and physical health outcomes for survivors, highlighting a need to hold institutions accountable for harm they cause. A limitation to this conceptualization is that many adults in the general public are not proximally connected to institutions (as they have historically been defined), and the majority of survivors do not formally report. Drawing on semi-structured interviews conducted with young women survivors (n = 12), the present study aims to address this gap by abstracting the conceptualization to a more macro level, proposing the term secondary institutional betrayal. Secondary institutional betrayal refers to survivors' feelings of mistrust and disillusionment toward institutions they are distally connected to which are not directly involved in their own assault (e.g., the media, U.S. government, U.S. criminal legal system, their university), yet still have influence over their personal safety and survival. This sense of betrayal stems from secondhand observations, through the news media, of how other survivors are treated by these institutions. Many survivors in the present study reported their secondhand observations of institutional betrayal would likely deter them from reporting future assaults. Establishing research in this area is important to understand how survivors in the general public are impacted by news stories which highlight institutional betrayal, particularly in the context of ongoing social movements (e.g., #MeToo) which amplify public discourse about sexual assault. [ABSTRACT FROM AUTHOR]

Background: Research suggests that doula support improves birth outcomes, contributing to lower rates of preterm birth, low birthweight, and nonindicated cesarean delivery. Few studies investigate whether doula support is associated with the quality of patient‐reported birth experiences in hospital settings. Methods: This study uses data from Listening to Mothers in California, a statewide representative survey of women who gave birth in 2016 in Californian hospitals. The analytic sample included 1345 English‐speaking participants. We used multivariable logistic regression to test for associations between doula support and self‐reported unfair treatment, abuse, and rapport with delivery staff. We also examined associations between these experiences and openness to doula support in a future birth. Models adjusted for maternal sociodemographic characteristics and views about medical intervention in birth. Results: Just over 9% of women had doula support during birth. During their hospital stay, 6.3% reported unfair treatment, 11.5% reported abuse by providers, and 5.7% reported no rapport with delivery room staff. There were no statistically significant relationships between doula support and unfair treatment, abuse, or delivery staff rapport in our models. Participants who reported no rapport with hospital staff were more likely to express openness to doula support in a future birth (AOR: 2.59; 95% CI: 1.15, 5.79). Conclusions: Despite their best efforts, doulas may not be able to mitigate all negative interactions between their clients and hospital staff. These experiences may also influence desires for additional support from doulas in future births. Hospital policies and practices should include doulas as valuable members of the care team to help ensure positive experiences during birth. [ABSTRACT FROM AUTHOR]

Respectful maternity care (RMC) is a crucial strategy in improving postpartum experiences of mothers. This study aimed to explain women's perception of determining aspects and determinants of disrespect and abuse (D&A) during childbirth. This study was carried out from October 2019 to February 2020 in Tabriz-Iran. A total of 12 postpartum women were enrolled in this qualitative study by purposive sampling. The data were collected through in-depth semi structured interviews and simultaneously analyzed with a conventional content analysis approach. Thirty eight sub-themes and 11 main themes extracted from data analysis. The main themes included: "physical abuse," "psychological violence," "discrimination," "violation of privacy," "unmet needs and preferences," "nonparticipation in decision-making," "abandonment of women," "Lack of sympathy," "shortage of human and non-human resources," "unpleasant psychological atmosphere of the ward" and "facilitators of D&A." The results of our study indicated the importance of sympathy with mothers and professional ethics. Moreover, healthcare providers, administrators, and policy-makers should design patient-centered interventions in order to secure the material, psychological, and legal needs of women to receive respectful maternity care. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to identify human rights violations of patients during the early periods of the COVID-19 pandemic in Ghana by investigating the experiences of people on how health-care professionals discharged their responsibilities during the time in question. Design/methodology/approach: Explanatory design of the mixed methods approach was adopted, with the intention of collecting both quantitative and qualitative data sequentially, and then integrating the results at the interpretation stage. The approach enriched the quality of data collected as it offered the advantage of shedding light on the primary motivations and reasons for attitudes and behaviours and helped to provide an in-depth understanding of how individuals interpret the happenings around them and their experiences. Thus, although some amount of quantitative method was used in the data collection, the core of this paper is based on the qualitative interpretations. Findings: The study reveals that health-care professionals, especially those in the Tema Metropolis, undermined certain fundamental human rights of patients during the early period of the COVID-19 pandemic. This includes failure to provide information to patients about treatment options and potential risks of medications; failure to seek the informed consent of patients before performing medical procedures; denial of access to medical files of patients for transfer; and inability or failure to provide medical ambulances services to patients on time. Originality/value: Although many publications on human rights dimensions and health protective issues on COVID-19 pandemic are available on a global scale, still little information pertaining to experiences of individuals with health-care professionals during the early days of the COVID-19 pandemic, especially in Ghana through the lens of patient's rights exists. This paper, therefore, fills an important gap in health-care management information, critical for policy decision-making processes regarding patient's rights in times of pandemic control. [ABSTRACT FROM AUTHOR]

Background: Gender minority (GM; individuals whose gender is not aligned with that traditionally associated with the sex that was assigned to them at birth) people have widely reported mistreatment in healthcare settings. Mistreatment is enacted by individuals within society who hold stigmatizing beliefs. However, the relationship between healthcare mistreatment and societal stigma (i.e., the degree to which society disapproves of GM people) is unclear and not measured consistently. Methods: We analyzed data from 2,031 GM participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study's 2019 Annual Questionnaire to determine whether societal stigma was associated with participants' past-year reports of mistreatment (defined as denial of healthcare services and/or lower quality care) in medical or mental healthcare settings. We created a proxy measure of societal stigma by incorporating variables validated in existing literature. Participants reported whether they had experienced mistreatment in medical and mental health settings independently. Results: Healthcare denial and/or lower quality care during the past year was reported by 18.8% of our sample for medical settings and 12.5% for mental health settings. We found no associations between the societal stigma variables and past-year reports of healthcare denial and/or lower quality care in medical or mental healthcare settings. Conclusions: Although a high proportion of GM people reported past-year healthcare mistreatment in both medical and mental health settings, mistreatment had no relationship with societal stigma. Factors other than societal stigma may be more important predictors of healthcare mistreatment, such as healthcare workers' knowledge of and attitudes toward GM people. However, other measures of societal stigma, or different types of mistreatment, may show stronger associations. Identifying key factors that contribute to mistreatment can serve as targets for intervention in communities and healthcare settings. [ABSTRACT FROM AUTHOR]

Low uptake of COVID vaccines within Black communities is a concern given the stark racial inequities associated with the pandemic. Prior research details COVID vaccine perceptions within the general population and Black communities specifically. However, Black individuals with long COVID may be more or less receptive to future COVID vaccination than their peers without long COVID. The impact of COVID vaccination on long COVID symptoms is still controversial, since some studies suggest that vaccination can improve long COVID symptoms, whereas other studies report no significant change in symptoms or a worsening of symptoms. In this study, we aimed to characterize the factors influencing perceptions of COVID vaccines among Black adults with long COVID to inform future vaccine-related policies and interventions. We conducted 15 semi-structured, race-concordant interviews over Zoom with adults who reported physical or mental health symptoms that lingered for a month or more after acute COVID infection. We transcribed and anonymized the interviews and implemented inductive, thematic analysis to identify factors influencing COVID vaccine perceptions and the vaccine decision-making process. We identified five themes that influenced vaccine perceptions: (1) Vaccine safety and efficacy; (2) Social implications of vaccination status; (3) Navigating and interpreting vaccine-related information; (4) Possibility of abuse and exploitation by the government and scientific community; and (5) Long COVID status. Safety concerns were amplified by long COVID status and mistrust in social systems due to mistreatment of the Black community. Among the factors influencing COVID vaccine perceptions, participants reported a desire to avoid reinfection and a negative immune response. As COVID reinfection and long COVID become more common, achieving adequate uptake of COVID vaccines and boosters may require approaches that are tailored in partnership with the long COVID patient community. [ABSTRACT FROM AUTHOR]

Background and Objectives Person-centered care (PCC) applied to elder mistreatment interventions is an approach to include victim priorities. Although PCC may improve outcomes by supporting choice, victim preferences are often difficult to support, especially in high-risk situations. We studied the adaptation of PCC structures and process to a pilot intervention, aimed at including client preferences in a multidisciplinary team's plans to address complex elder mistreatment. Research Design and Methods Case study analysis was used to examine the process of integrating client priorities into a risk-reduction plan. A well-being framework was used to understand the relationship between safety and preferences. Purposive sampling identified a case study of a high-risk victim with history of refusing help who agreed to work with the Service Advocate, a member of a multidisciplinary team. Results PCC required a relationship of trust, honed over several weeks by prioritizing the clients' perspective. Client preferences included remaining at home, continuing the relationship with the abuser, and maintaining a sense of mastery. Individualized definitions of "safety" were unrelated to elder mistreatment risk. Assistance included working with the suspected perpetrator, which is not offered by most elder mistreatment interventions, and resulted in some risk reduction. Reasons for refusing help were a desire for control and fear of loss of well-being assets. Discussion and Implications Individualized definitions of well-being should be considered in measuring intervention success. Future research could determine guidelines on what levels of elder mistreatment risk are acceptable, and how to monitor clients for safety while supporting autonomy. [ABSTRACT FROM AUTHOR]

Black individuals are at particularly high risk for birth-related posttraumatic stress disorder (PTSD) symptoms, in part due to a lack of opportunity to lead maternity care decisions. Maternal care providers need evidence-based ways to reduce pregnant persons' risk for birth-related PTSD symptoms despite reduced autonomy in decision making resulting from heightened restrictions on reproductive rights. We investigated whether a potential relation between autonomy in decision making and birth-related PTSD symptoms would be moderated by being mistreated or feeling respected by maternity care providers in a community sample of Black women (N = 52; Mage = 28.2 years, SDage = 5.7 years) seeking maternity care at a public hospital in the southeastern United States. At six weeks postpartum, participants completed measures assessing autonomy in decision making, current birth-related PTSD symptoms, number of mistreatment events, and feelings of respect from providers during pregnancy, childbirth, and the postpartum period. Autonomy in decision making was negatively correlated with birth-related PTSD symptoms, r=−.43, p <.01. An interaction between autonomy in decision making and mistreatment by providers was trending toward significance, B=−.23, SE=.14, p =.10. Autonomy in decision making and feeling respected by maternity care provider interacted to predict birth-related PTSD symptoms, B =.05, SE=.01, p <.01. Feeling respected by providers may buffer against the negative effects of lack of autonomy in decision making on birth-related PTSD symptoms, highlighting the importance of providers' ability to convey respect to pregnant patients when they cannot lead care decisions. [ABSTRACT FROM AUTHOR]

Providers' disrespect and abuse of patients is a recognized but understudied issue affecting quality of care and likely affecting healthcare utilization. Little research has examined this issue among people living with HIV (PWH) who inject drugs, despite high stigmatization of this population. No research has examined this issue in the context of Russia. This study assesses patients' reports of disrespect and abuse from providers as a barrier to healthcare and examines the association between these reports and HIV care outcomes.We conducted a cross-sectional analysis of the associations between disrespect/abuse from health providers as a barrier to care and the following HIV care outcomes: (i) anti-retroviral treatment (ART) uptake ever, (ii) past 6-month visit to HIV provider, and (iii) CD4 count. Participants (N  = 221) were people living with HIV who injected drugs and were not on ART at enrollment.Two in five participants (42%) reported a history disrespect/abuse from a healthcare provider that they cited as a barrier to care. Those reporting this concern had lower odds of ever use of ART (adjusted odds ratio 0.46 [95% CI 0.22, 0.95]); we found no significant associations for the other HIV outcomes. We additionally found higher representation of women among those reporting prevalence of disrespect/abuse from provider as a barrier to care compared to those not reporting this barrier (58.1% versus 27.3%).Almost half of this sample of PWH who inject drugs report disrespect/abuse from a provider as a barrier to healthcare, and this is associated with lower odds of receipt of ART but not with other HIV outcomes studied. There is need for improved focus on quality of respectful and dignified care from providers for PWH who inject drugs, and such focus may improve ART uptake in Russia. [ABSTRACT FROM AUTHOR]

The aim of this study was to give a voice to Arab and Jewish women in Israel who had suffered obstetric violence during various stages of fertility treatments, pregnancy, and childbirth and also to learn from the women about their experiences of obstetric violence subject to the barriers of the Israeli health system, and their recommendations of possible solutions. The study underlines the unique gender, social, and cultural context in Israel concerning pregnancy and childbirth, and was based on the feminist approach that strives to promote human rights, and eradicate phenomena of gender-related, patriarchal, and social structures. The study used a qualitative-constructivist methodology. Twenty semi-structured interviews with ten Arab women and ten Jewish women were thematically analyzed, and five main themes emerged: first, the women's experience of becoming pregnant and pregnancy overshadowed by physical and emotional barriers from caregivers and the close environment; second, the women's awareness of their bodies and needs during pregnancy dominated by the challenges of the health services; third, the women's awareness of their bodies and needs during childbirth alongside incompatible expectations and nonattentive medical staff; fourth, the women's descriptions of experiences and types of obstetric violence; and fifth, the women's recommendations to eradicate obstetric violence. [ABSTRACT FROM AUTHOR]

An editorial is presented about responding to media coverage of recent mental health service failures, discussing portrayals of poor practice and proposing changes in mental health nurse education to address the root causes. It highlights the global nature of human rights abuses and coercive practices in psychiatric care, emphasizing the need for education to instill values and practices that counter prevailing difficulties within mental health care.

In India, opioid addiction is a serious emerging problem. Opioid substitution therapy (OST), particularly buprenorphine, has been shown to be very cost-effective and has significant evidence of reduced drug-related HIV risk behaviors, crime, and illegal opioid usage. Raising the standard of living and enhancing public health is one of the main goals of this therapy, with a special emphasis on the center's efforts to promote harm reduction. However, incidents of reported patient abuse or misuse of these drugs frequently lead to unfavourable opinions of this crucial life-saving procedure. Therefore, the administration and government must move immediately to address the issue. [ABSTRACT FROM AUTHOR]

Background: Mistreatment during labour and childbirth is a common experience for many women around the world. This study aimed to explore the manifestations of mistreatment and its influencing factors in public maternity hospitals in Tehran. Methods: A formative qualitative study was conducted using a phenomenological approach in five public hospitals between October 2021 and May 2022. Sixty in-depth face-to-face interviews were conducted with a purposive sample of women, maternity healthcare providers, and managers. Data were analyzed with content analysis using MAXQDA 18. Results: Mistreatment of women during labour and childbirth was manifested in four form: (1) physical abuse (fundal pressure); (2) verbal abuse (judgmental comments, harsh and rude language, and threats of poor outcomes); (3) failure to meet professional standards of care (painful vaginal exams, neglect and abandonment, and refusal to provide pain relief); and (4) poor rapport between women and providers (lack of supportive care and denial of mobility). Four themes were also identified as influencing factors: (1) individual-level factors (e.g., providers' perception about women's limited knowledge on childbirth process), (2) healthcare provider-level factors (e.g., provider stress and stressful working conditions); (3) hospital-level factors (e.g., staff shortages); and (4) national health system-level factors (e.g., lack of access to pain management during labour and childbirth). Conclusions: Our study showed that women experienced various forms of mistreatment during labour and childbirth. There were also multiple level drivers for mistreatment at individual, healthcare provider, hospital and health system levels. Addressing these factors requires urgent multifaceted interventions. Plain language summary: Mistreatment during labour and childbirth is a common experience for many women around the world. A picture of the nature and types of mistreatment; and especially its influencing factors has not yet been identified in Iran. A qualitative approach to explore manifestations of mistreatment during labour and childbirth while learning about the factors that influence them was used for this study. It obtained this information thanks to semi-structured interviews with women, maternity healthcare providers, and managers between October 2021 and May 2022. Our findings showed that women experienced various forms of mistreatment during labour and childbirth. At individual level, e.g., providers' perception about women's limited knowledge on childbirth process was an influencing factor for mistreatment. At healthcare provider level, a highlighted factor was provider stress and stressful working conditions. At hospital level, e.g., staff shortages played a main role; and at national health system level, participants believed that lack of access to pain management during labour and childbirth was an influencing factor for mistreatment. These findings can provide a good platform for designing and implementing intervention programs to reduce disrespectful maternity care. It can also be used as a guide for managers and policymakers to improve the quality of services provided to women. [ABSTRACT FROM AUTHOR]

Background: Analyses of factors that determine quality of perinatal care consistently rely on clinical markers, while failing to assess experiential outcomes. Understanding how model of care and birth setting influence experiences of respect, autonomy, and decision making, is essential for comprehensive assessment of quality. Methods: We examined responses (n = 1771) to an online cross-sectional national survey capturing experiences of perinatal care in the United States. We used validated patient-oriented measures and scales to assess four domains of experience: (1) decision-making, (2) respect, (3) mistreatment, and (4) time spent during visits. We categorized the provider type and birth setting into three groups: midwife at community birth, midwife at hospital-birth, and physician at hospital-birth. For each group, we used multivariate logistic regression, adjusted for demographic and clinical characteristics, to estimate the odds of experiential outcomes in all the four domains. Results: Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy (aOR: 5.22, 95% CI: 3.65–7.45), higher respect (aOR: 5.39, 95% CI: 3.72–7.82) and lower odds of mistreatment (aOR: 0.16, 95% CI: 0.10–0.26). We found significant differences across birth settings: participants cared for by midwives in the community settings had significantly better experiential outcomes than those in the hospital settings: high- autonomy (aOR: 2.97, 95% CI: 2.66–4.27), respect (aOR: 4.15, 95% CI: 2.81–6.14), mistreatment (aOR: 0.20, 95% CI: 0.11–0.34), time spent (aOR: 8.06, 95% CI: 4.26–15.28). Conclusion: Participants reported better experiential outcomes when cared for by midwives than by physicians. And for those receiving midwifery care, the quality of experiential outcomes was significantly higher in community settings than in hospital settings. Care settings matter and structures of hospital-based care may impair implementation of the person-centered midwifery care model. [ABSTRACT FROM AUTHOR]

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Introduction: Research exploring the mistreatment of birthing people in the United States is emerging rapidly within the context of increasingly poor maternal health outcomes that include unacceptable racial disparities. Previous research has explored overlap between psychological birth trauma and mistreatment using patient descriptions of birth experiences, but no previous studies have explored these issues from the perspectives of clinicians. The aim of this study was to explore whether maternity care providers' descriptions of patient birth trauma overlap with categories of mistreatment from a globally accepted typology. Methods: Content analysis was performed on a qualitative data set of 28 semi-structured interviews about patient birth trauma, completed in 2018–2019 with U.S. maternity care clinicians, including obstetricians, family physicians, midwives and labor/delivery nurses. The interviews were part of a larger study exploring maternity clinician perspectives and experiences of patient birth trauma. For this analysis Krippendorff's method of categoric distinction was used, with categories from a globally recognized typology of maternity patient mistreatment. Results: Clinicians' descriptions of their experiences with patient birth trauma mapped onto all seven mistreatment categories, although no interview questions specifically asked about mistreatment. In more than 30 hours of interviews, transcribed to more than 800 pages, the word mistreatment appears only once, suggesting that some healthcare providers may use the phrase "birth trauma" as a euphemism to describe mistreatment. Eighteen of 28 interviews included at least one description that fit into a mistreatment category. "Failure to meet professional standards of care" was the category with the most mapped clinician statements, followed by "Stigma and discrimination" and "Poor rapport between women and providers." Conclusions: This study contributes new insight into maternity clinicians' conceptualization of patient trauma and how their descriptions of birth trauma overlap with mistreatment. Clinicians implicitly connected mistreatment with some patient experiences of birth trauma, even when they were not specifically asked about mistreatment. Findings point to a need for further research into mistreatment, including routinized "everyday care" that may include mistreatment, particularly for marginalized and historically excluded birthing people. Future research also must explore the potential role of mistreatment in poor and inequitable U.S. birth outcomes. Plain language summary: Many people giving birth in the United States experience poor health outcomes, and there is a wide racial disparity, with people of color more likely to experience poor outcomes. In recent research, birthing people reported that they were mistreated during their labor and delivery, including being shouted at, scolded, or threatened. Mistreatment accounts were more frequent among women of color. Previous research has looked at patient reports about their birth experiences to explore whether their descriptions of psychological trauma include overlap with mistreatment, but no other studies have looked at descriptions of birth trauma from the perspectives of medical clinicians. The objective of this study was to explore whether maternity care providers' descriptions of patient birth trauma overlap with categories of mistreatment from a globally accepted list. This study analyzed the content of 28 semi-structured interviews about patient birth trauma, completed in 2018–2019 with obstetricians, family physicians, midwives and labor/delivery nurses. In the interviews, participant descriptions of patient birth trauma fit into all seven mistreatment categories. Participant descriptions included examples of patients receiving medical procedures or treatments without first giving consent, nurses avoiding the rooms of patients who do not speak English, and other forms of mistreatment. Participants were not asked specifically about mistreatment, but they described birth trauma by giving examples of mistreatment, which suggests that some healthcare providers may use the phrase "birth trauma" when talking about "mistreatment." This study shows a need for further research into mistreatment, including routine "everyday care" that may include mistreatment. [ABSTRACT FROM AUTHOR]

Introduction. Safety is an essential factor in patient recovery, occupational well-being, and a well-functioning care environment. To identify and understand potential safety risks, information from safety incidents is needed. Aim. To describe safety incidents that occurred on psychiatric inpatient wards. Method. A retrospective register study. The data were collected from a web-based incident reporting database (HaiPro) from six Finnish psychiatric inpatient wards. The incident reports (N = 76) were analysed with descriptive statistics and inductive content analyses. Results. The incidents were verbally or physically aggressive situations, rule violations, or challenges in the ward's basic activities. The incidents resulted in consequences for patients, personnel, and the wards with varying severity. Some of the incidents could have possibly been prevented with simple, practical measures, such as sharing information, being prepared for safety practices, and having comprehensively planned care. Discussion. Safety incidents cause fear and challenges and could partly be prevented with multiprofessional and multilevel cooperation. Implications for Practice. Preventative actions include multidisciplinary and ward-specific education for safety practices, ensuring resources and not having too many patients on the ward. Multiprofessional communication and mutual understanding, including patient participation, are central. Wards should be designed or renovated so that safe environments can be guaranteed. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders of pregnancy (HDP) remain a leading global health problem with complex clinical presentations and potentially grim birth outcomes for both mother and fetus. Improvement in the quality of maternal care provision and positive women's experiences are indispensable measures to reduce maternal and perinatal adverse outcomes. Objective: To explore the perspectives and lived experiences of healthcare provision among women with HDP and the associated challenges. Methods: A multi-center qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in five major referral hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Women between 26 and 34 weeks' gestation with confirmed HDP who received maternity care services were eligible to participate. Thematic content analysis was performed using the inductive analytic framework approach. Results: Fifty IDIs and three FGDs (with 22 participants) were conducted. Most women were between 20 and 30 years, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. Women reported mixed (positive and negative) experiences of maternal care. Positive experiences reported include receiving optimal quality of care, satisfaction with care and good counselling and reassurance from the health professionals. Negative experiences of care comprised ineffective provider–client communication, inappropriate attitudes by the health professionals and disrespectful treatment including verbal and physical abuse. Major health system factors influencing women's experiences of care included lack of logistics, substandard professionalism, inefficient national health insurance system and unexplained delays at health facilities. Patient-related factors that influenced provision of care enumerated were financial limitations, chronic psychosocial stress and inadequate awareness about HDP. Conclusion: Women with HDP reported both positive and negative experiences of care stemming from the healthcare system, health providers and individual factors. Given the importance of positive women's experiences and respectful maternal care, dedicated multidisciplinary women-centered care is recommended to optimize the care for pregnant women with HDP. Plain language summary: High blood pressure (hypertension) in pregnancy can have severe complications for both mother and fetus including loss of life. The outcome of pregnancy for women who develop hypertension during pregnancy can be improved by ensuring optimal quality of care. In this study, we explored the opinions and experiences of women whose pregnancies were affected by hypertension concerning the care they received during their recent admission at different hospitals in Ghana and the challenges they faced. In four major referral hospitals in the Greater Accra Region of Ghana, we interviewed the women and had focus group discussions. Women who were pregnant for 26 weeks up to 34 weeks and had hypertension in pregnancy were invited for inclusion in the study. We conducted in-depth interviews with fifty women and three focus group discussions with 22 women. Most women who participated in the study were between 20 and 30 years old, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. The women reported both positive and negative experiences of care during their admission at the hospitals. Examples of positive experiences were receiving good quality of care, satisfaction with care, and adequate counselling from the health workers. Examples of negative experiences were poor communication between the providers and affected women, inappropriate attitudes by the healthcare providers, and disrespectful treatment such as verbal and physical abuse. The major factors in the health system that influenced women's experiences of care were lack of logistics, substandard professionalism, inefficient national health insurance system and long delays at health facilities prior to receiving treatment. The individual women's factors that affected the quality of care included financial constraints, psychosocial stress and inadequate knowledge about hypertension during pregnancy. In conclusion, we determined that women with hypertension in pregnancy experience both positive and negative aspects of care and these may be due to challenges associated with the healthcare system, health providers and women themselves. There is the need to ensure optimal quality and respectful maternity care considering the nature of hypertension in pregnancy. These women require dedicated hospital staff with significant experience to improve the quality of care provided to women with hypertension in pregnancy. [ABSTRACT FROM AUTHOR]

Hannah Ellis, Emily Ellis and Peter Ellis discuss the legal legislation surrounding safeguarding and explore how it applies to kidney care specialists [ABSTRACT FROM AUTHOR]

The relationship between mental health and human rights is complex and bidirectional. Global mental health movements have been emphasizing the promotion of human rights in mental health care in accordance with the UN Convention on the Rights of Persons with Disabilities and the WHO QualityRights Initiative. The main objective of this review is to have an overview of the current global situation of human rights in mental health services by performing a review of scientific literature. The literature search and elimination process yielded a total of 26 articles focussing on human rights-related reports and tools. Further assessment of these articles clearly shows that despite significant improvements in mental health service delivery in the past decade, there is still substantial reporting of the continuing prominence of stigmatizing attitudes, and human rights violations and abuses in mental health settings. The human rights perspective requires society, particularly policymakers, to actively promote necessary conditions for all individuals to fully realize their rights. We suggest developing a more comprehensive model in mental health that integrates human rights into existing services and approaches. A model that recognizes that all people with mental health conditions and psychosocial disabilities are rights holders. [ABSTRACT FROM AUTHOR]

Poor care has been back in the spotlight following two TV exposés. Undercover filming by the BBC Panorama programme highlighted alleged verbal and physical abuse of patients at the Edenfield Centre, a secure mental health unit in Greater Manchester. [ABSTRACT FROM AUTHOR]

Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism following initial injury. While the burden of violence is disproportionately felt among young Black men and in communities of color, examination of distinct risk factors and long-term outcomes for other racial and ethnic groups could lead to improved violence intervention strategies. In this study, we examined the risk of violent penetrating injury and long-term adverse outcomes by race and ethnicity. This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a violent penetrating injury between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for the risk of all-cause mortality and violent re-injury at one and 3 years after surviving a penetrating injury. Of the 4191 victims of violent injury, 12% were White, 18% were Hispanic, and the remaining 70% self-identified as Black. Within 3 years after initial injury, Black patients were at the greatest risk of all-cause violent re-injury (vs. Hispanic: HR = 1.46, 95%CI[1.15,1.85], p = 0.002; vs. White: HR = 1.89, 95%CI[1.40,2.57], p < 0.0001), particularly by gunshot wound (vs. Hispanic: HR = 2.04, 95%CI[1.29,3.22] p = 0.002; vs. White: HR = 2.34, 95%CI[1.19,4.60], p = 0.01). At 3-years following initial injury, White patients were at 2.03 times the risk for all-cause mortality, likely due to a 4.96 times greater risk of death by drug or alcohol overdose for White patients compared to Black patients (HR = 4.96, 95%CI[2.25,10.96], p < 0.0001). In conclusion, Black survivors of violent injury have a significantly higher risk of violent re-injury, particularly by gun violence, while White patients are at the highest risk for mortality due to the incidence of drug and alcohol overdose. Violence intervention programs with similar patient populations should explore options to collaborate with drug treatment programs to reach this vulnerable population. [ABSTRACT FROM AUTHOR]