FREDA: a human rights-based approach to healthcare

Unravelling elder abuse through a human rights lens: a case study

This article examines the connection between human rights and elder abuse, employing a human rights-based approach. Through a critical examination of a fictional case study on elder abuse, the discussion highlights the vital role of nurses when safeguarding the rights of older individuals in residential care settings. The PANEL framework - encompassing Participation, Accountability, Non-discrimination, Empowerment and Legality - is a comprehensive guide for safeguarding practice and is applied to the example provided. By applying this human rights-based approach, nurses can proactively address elder abuse, ensuring individuals' rights are protected, promoted and supported. Through accountability measures, non-discriminatory practices, empowerment strategies and adherence to legal standards, the authors advocate for a holistic approach to enhance the quality of care and foster a safe environment for older adults.

Applying the theory of planned behaviour to understand mental health professionals' intentions to work using a human rights-based approach in acute inpatient settings

BACKGROUND

There has been a shift to implement human rights-based approaches in acute mental health care due to increasing concerns around quality of care. National Health Service (NHS) Trusts have a legal duty to uphold a person's human rights, therefore it is important to understand what any barriers might be. Using psychological theory may help to develop this understanding.

AIM

To test whether the theory of planned behaviour can be an effective model in understanding mental health professionals' intentions to work using a human rights-based approach.

METHOD

Participants were recruited from two NHS Trusts in the North West of England. A cross-sectional, survey design was used to examine mental health professionals' intentions to use human rights-based approaches.

RESULTS

Multiple regression analyses were performed on the theory of planned behaviour constructs showing that attitude and subjective norm significantly predicted intention. Perceived behavioural control did not add any significant variance, nor any demographic variables.

CONCLUSION

There could be factors outside of the individual clinician's control to fully work within a human rights-based framework on acute mental health wards. The theory of planned behaviour offers some understanding, however further development work into measuring human rights outcomes on acute mental health wards is needed.

Contributing Factors to Adverse Events in Long-Term Care Facilities in Ireland, a Content Analysis

OBJECTIVES

There is substantial research on contributing factors to adverse events (AEs) in acute settings. Little is known about AEs in long-term care facilities (LTCFs). Our aim was to identify contributing factors to AEs from LTCFs for older persons and people with disability to inform quality improvement.

DESIGN

Content analysis of statutory notifications of AEs from LTCFs using a modified version of the Human Factors Analysis and Classifications System (HFACS) applied to health care.

SETTING

A sample of high risk-rated notifications of AEs received by the regulator in 2018 and 2019 was drawn from the Database of Statutory Notifications from Social Care in Ireland (n = 156).

METHODS

Two researchers independently analyzed notifications to identify contributing factors using our modified HFACS. The number of factors identified in each level, subcategory, and nanocode of the HFACS was calculated along with percentage representation of factors within notifications and percentage contribution of individual factors to the total number of factors identified. The number and percentage contributions of factors were also calculated, disaggregated by notification type.

RESULTS

Contributing factors from all levels of the HFACS were identified. The most common contributing factor was "Resident factors" followed by "Unsafe acts." No contributing factors were attributed to 68 notifications (43.6%). Multiple contributing factors were attributed to 45 notifications (28.8%). The largest percentage of factors was identified in notifications of serious injuries (27.4%).

CONCLUSION AND IMPLICATIONS

It is the responsibility of LTCFs to account for "Resident factors" in system design, risk management, and care plans. Developing systems and processes that identify where residents have higher risk of harm may reduce the occurrence of high-risk events and thus improve resident safety. The large proportion of notifications where no contributing factors were identified suggests the need for improved reflection and reporting from LTCFs and for more specific questions on notification forms.

Perceived Detention Environment and Mental Health of Detainees in Immigration Detention Centers in Spain

The increase in migratory flows worldwide has led to the creation of detention centers as a form of control of irregular migration. Recipient countries are responsible for protecting detainees' right to mental health, but the literature suggests that immigration detention centers are environments associated with complex mental health needs among the detainees. This study aims to approach the mental health of people detained in the immigration detention centers in Spain, a southern border of Europe. Eighty-seven migrants coming from different Latin American and African countries were interviewed using an adaptation of the Measure of Quality of Life in Detention (MQLD; Bosworth & Gerlach, 2020) to measure the perceived detention environment and The Hopkins Symptom Checklist-25 (HSCL-25; Derogatis et al., 1974) to assess mental health. The results show a high prevalence of detainees with significant levels of anxiety and depression (69%) and attempts at self-harm within the detention centers (19.5%). A more positive perception of the detention environment-especially concerning institutional decency and the relationship with officers-is related to a lower degree of negative mental health symptoms. Finally, people detained for more than 2 weeks assess the detention environment more negatively than those detained for less time. Scientific contributions and social implications to ensure the mental health of detainees from a human rights-based approach are discussed.

Translating Cultural Safety to the UK

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be 'culturally safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.

Sexual and reproductive health needs assessment and interventions in a female psychiatric intensive care unit

AIMS AND METHOD

To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments and interventions in this setting. Within a quality improvement framework, staff were trained, a clinical protocol developed and clinical interventions made accessible.

RESULTS

Thirty per cent of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. Forty-two per cent of women were assessed, representing a 3.5-fold increase in uptake. Twenty-one per cent of women initiated SRH interventions, of which 14% had all their SRH needs met. Staff, patients and carers highlighted the acceptability and importance of SRH care, if interventions were appropriately timed and patients' individual risk profiles were considered. Barriers to access included lack of routine enquiry, illness acuity and impact of the COVID-19 pandemic.

CLINICAL IMPLICATIONS

SRH needs for PICU admissions are greater than previously realised. Providing a nurse-led SRH assessment is acceptable, feasible and beneficial for PICU patients.

'As for dignity and respect…. me bollix': A human rights-based exploration of service user narratives in Irish methadone maintenance treatment

INTRODUCTION

This paper explores the narratives of service users of contemporary methadone maintenance treatment services (MMT) in the Republic of Ireland to obtain their perspectives in the context of them negotiating their right to health METHODS: Participants were recruited and interviewed by a former service user of MMT services. In-depth qualitative interviews were conducted with 40 current and recent users of MMT services RESULTS: Participants overwhelmingly reported a reduced sense of personal agency because of their experiences in MMT treatment. Participants observed that their perceptions of treatment were forged by a sense of reduced autonomy, coercive and disrespectful approaches from healthcare workers. Within a system which the participants considered to be failing, the services that they accessed were predicated on a process of reward and punishment, where best practice was often ignored by practitioners, all of which resulted in adverse consequences for service users DISCUSSION: The findings indicate that there is a significant 'chasm' between human rights, policy and best practice and how these are operationalised within the structures and practices of Irish MMT services. The treatment of service users, based on human rights principles such as equality, respect, autonomy, empowerment and personal choice remains aspirational and is unlikely to be fulfilled without addressing more systemic challenges such as funding, training of staff, service culture, governance and independent oversight of MMT services.

Human rights and nutritional care in nurse education: lessons learned

Background: Food is an important part of nursing care and recognized as a basic need and a human right. Nutritional care for older adults in institutions represents a particularly important area to address in nursing education and practice, as the right to food can be at risk and health personnel experience ethical challenges related to food and nutrition. Objective: The present study investigates the development of coursework on nutritional care with a human rights perspective in a nursing programme for first-year nursing students and draws upon reflections and lessons learned. Research design: The study utilized educational design research. The coursework, developed through two rounds, combined on-campus learning and clinical placement in nursing homes. Nursing studentsʼ perspectives and experiences gathered through focus groups and a written assignment informed the development and evaluation of the coursework. Participants and research context: In the first round, multistage focus group interviews were conducted with 18 nursing students before, during and after placement. In the second round, four focus group interviews with 26 nursing students were conducted shortly after placement. Ethical consideration: The study was approved by the Norwegian Centre for Research Data. Findings: Three main ʽlessons learnedʼ emerged regarding introducing a human rights perspective in nursing education: 1) the contribution of the human rights perspective in changing the narrative of ʽvulnerable and malnourished patientsʼ, 2) the importance of relationships and experiences for learning about human rights and 3) the benefit of combining development of ethical competence with a human rights perspective. Conclusion: A human rights perspective enabled the students to give meaning to nutritional care beyond understanding of food as a basic physical need. Incorporating human rights in nursing education can support nursing students and nurses in recognizing and addressing ethical and structural challenges and being able to fulfil the right to food for patients.

Improving safety by developing trust with a just culture

This article presents a simple conceptual road map for implementing a just culture in healthcare settings. The concept of just culture was developed as one of five fundamental elements of a safety culture by psychology professor James Reason in 1997. A just culture requires an unbiased method of judging human error and is designed to develop organisational trust so that adverse medical events (errors) are reported and corrected before they combine with other errors to cause injury or death. To implement a just culture properly so as to increase organisational safety, practitioners must understand its role in enabling the error reporting needed to develop a safety culture. This article reviews these foundational concepts and explores the human causes of errors that a just culture addresses, the psychological importance of a just culture in enabling error reporting and how to implement a just culture in organisations.

Patients' healthcare, education, engagement, and empowerment rights' framework: Patients', caretakers' and health care workers' perspectives from Oromia, Ethiopia

BACKGROUND

Successful health care and clinical services essentially depend on patients' realization of ones' rights, and health workers' and facilities' fulfillments and protections of these rights. However, little is documented about how patients and health workers perceive patients' rights during care-seeking practices.

METHODS

A qualitative study was conducted in four hospitals in Ethiopia through 8 focus group discussions with patients and 14 individual interviews with diverse groups of patients, caretakers, and 14 interviews with health workers. Participants were recruited through a purposive sampling method to meet the saturation of ideas about patients' rights. The sampled patients, caretakers, and professionals were enlisted from various departments in the hospitals. The data analysis was assisted by ATLAS.ti 7.1.4.

RESULTS

The study identified three major categories of healthcare rights (clinical, socio-cultural, and organizational), incorporating supporting elements of education, engagement, and empowerment. Study participants reported detailed rights the patients would have during hospital visits which included the right to timely access to care and treatment, adequate medications) with full respect, dignity, and without any discrimination. Patients widely perceived that they had the right to tell their illness history and know their illness in the language they can understand. It was also widely agreed that patients have the right to be educated and guided to make informed choices of services, procedures, and medications. Additionally, patients reported that they had the right to be accompanied by caretakers together with the right to use facilities and resources and get instructions on how to utilize these resources, the right to be protected from exposure to infections and unsafe conditions in hospitals, right to get a diet of their preference, and right to referral for further care. Nevertheless, there was a common concern among patients and caretakers that these rights were mostly non-existent in practice which were due to barriers related to patients (fear of consequence; a sense of dependency, feeling of powerlessness, perceptions of low medical literacy), health workers (negligence, lack of awareness and recognition of patient rights, undermining patients), and facilities' readiness and support, including lack of guiding framework.

CONCLUSIONS

Perceived patients' rights in the context of hospital visits were profoundly numerous, ranging from the right to access clinical and non-clinical services that are humanely respectful, fulfilling socio-cultural contexts, and in a manner that is organizationally coordinated. Nonetheless, the rights were not largely realized and fulfilled. Engaging, educating, and empowering patients, caretakers, and health care providers supported with policy framework could help to move towards patient-centered and right-based healthcare whereby patients' rights are protected and fulfilled in such resource-limited settings.

The meaning of autonomy when living with dementia: A Q-method investigation

Background and Aims

Sensitivity to the rights of people with dementia is a key principle cited in the World Health Organisation’s global action plan on dementia. Some critics question whether rights-based approaches embody loose and ill-defined ideas incapable of bringing about meaningful change. Exercising the right to autonomy is considered a core problem for people living with dementia. The tradition of individual sovereignty dominates ideas about autonomy, although the person as an individual is not a cross-culturally universal concept. This study explored the viewpoints of people with dementia and family carers regarding the meaning of autonomy with a view to informing rights-based practice.

Methods

Twenty participants, people living with dementia and family carers, each conducted a Q-sort of statements regarding the meaning of autonomy. A by-person factor analysis was used to identify patterns in how the range of statements about autonomy were ranked.

Results

Three factors emerged: retaining independence and self-expression, accepting dependence but being included and opportunity for connection. There was some agreement across these different views regarding the importance of being given time to think before making decisions and being kept active.

Conclusions

This study highlights the need for a person-centred approach to supporting people with dementia to claim their rights and the importance of adopting a stance of curiosity and critical thinking in rights-based training and professional practice. The findings suggest a variety of meaningful stories of autonomy and the possibility of further developing existing rights-based frameworks for dementia care.

Understanding quality of life and well-being for people living with advanced dementia

AIM

To investigate the quality of life (QoL) and well-being of people living with advanced dementia in care homes.

METHOD

A mixed-methods approach was taken combining participant observations, interviews with the participants' families and carers, and quantitative measurements. The quantitative measures included AwareCare assessments, QoL in Late-Stage Dementia scale ratings and semi-structured interviews with relatives and staff members. Ryff's psychological well-being framework, the Fairness, Respect, Equality, Identity, Dignity, Autonomy principles, and Kitwood's indicators of well-being, were examined to attempt to identify contributors to QoL for people living with advanced dementia.

RESULTS

Participants had limited verbal abilities, but used non-vocal behaviours to communicate. These behaviours influenced their QoL and well-being.

CONCLUSION

The indicators of well-being in Kitwood's personhood model were helpful in describing how relatives and staff perceived the QoL of the person with dementia.

Mental health morbidity among people subject to immigration detention in the UK: a feasibility study

AIMS

The UK has one of the largest systems of immigration detention in Europe.. Those detained include asylum-seekers and foreign national prisoners, groups with a higher prevalence of mental health vulnerabilities compared with the general population. In light of little published research on the mental health status of detainees in immigration removal centres (IRCs), the primary aim of this study was to explore whether it was feasible to conduct psychiatric research in such a setting. A secondary aim was to compare the mental health of those seeking asylum with the rest of the detainees.

METHODS

Cross-sectional study with simple random sampling followed by opportunistic sampling. Exclusion criteria included inadequate knowledge of English and European Union nationality. Six validated tools were used to screen for mental health disorders including developmental disorders like Personality Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Autistic Spectrum Disorder (ASD) and Intellectual Disability, as well as for needs assessment. These were the MINI v6, SAPAS, AQ-10, ASRS, LDSQ and CANFOR. Demographic data were obtained using a participant demographic sheet. Researchers were trained in the use of the screening battery and inter-rater reliability assessed by joint ratings.

RESULTS

A total of 101 subjects were interviewed. Overall response rate was 39%. The most prevalent screened mental disorder was depression (52.5%), followed by personality disorder (34.7%) and post-traumatic stress disorder (20.8%). 21.8% were at moderate to high suicidal risk. 14.9 and 13.9% screened positive for ASD and ADHD, respectively. The greatest unmet needs were in the areas of intimate relationships (76.2%), psychological distress (72.3%) and sexual expression (71.3%). Overall presence of mental disorder was comparable with levels found in prisons. The numbers in each group were too small to carry out any further analysis.

CONCLUSION

It is feasible to undertake a psychiatric morbidity survey in an IRC. Limitations of the study include potential selection bias, use of screening tools, use of single-site study, high refusal rates, the lack of interpreters and lack of women and children in study sample. Future studies should involve the in-reach team to recruit participants and should be run by a steering group consisting of clinicians from the IRC as well as academics.

Using the lever of parity of esteem between mental and physical health to close the mental health gap -a call for action

This paper provides a six-point definition of what parity of esteem for mental health means in practice. It highlights examples of the current disparity between mental and physical health and the importance of redressing this. The significance of securing a legislative basis for parity in England is discussed. The authors make a call for action, and pose six questions for international readers to consider and respond to.

Evaluating 'FREDA Challenge': a coproduced human rights board game in services for people with intellectual disabilities

BACKGROUND

A serious board game called 'FREDA Challenge' was co-produced with people with intellectual disabilities (PWID) as a tool for human rights (HR) education and increase positive attitudes towards HR in healthcare settings. The current study evaluated 'FREDA Challenge' with PWID and their carers.

METHOD

Eighteen PWID and 13 carers participated in a repeated measures design whereby changes in attitudes and knowledge of HR were measured.

RESULTS

Analysis revealed statistically significant differences (P = 0.02) between PWID and carers in their knowledge of HR. The same was not evident for attitudes towards HR. The positive attitudes and knowledge in the PWID group significantly increased after playing the game (P ≤ 0.02), but not for the carers/professionals group.

CONCLUSIONS

Findings suggest that playing the board game can positively change the attitudes and knowledge of PWID towards HR. The board game seems to elicit positive interpersonal dynamics between PWID and carers/professionals.

The experiences of detained mental health service users: issues of dignity in care

Background

When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored.

Methods

This paper reports on the experiences of 19 adult service users who were, at the time of interview, detained under a Section of the MHA. These service users had experienced coercive interventions and they gave their account of how they considered their dignity to be protected (or not), and their sense of self respected (or not).

Results

The service users considered their dignity and respect compromised by 1) not being ‘heard’ by staff members, 2) a lack of involvement in decision-making regarding their care, 3) a lack of information about their treatment plans particularly medication, 4) lack of access to more talking therapies and therapeutic engagement, and 5) the physical setting/environment and lack of daily activities to alleviate their boredom.

Conclusions

Dignity and respect are important values in recovery and practitioners need time to engage with service user narratives and to reflect on the ethics of their practice.

Ethical issues evolving from patients' perspectives on compulsory screening for syphilis and voluntary screening for cervical cancer in Kenya

Background

Public health aims to provide universal safety and progressive opportunities to populations to realise their highest level of health through prevention of disease, its progression or transmission. Screening asymptomatic individuals to detect early unapparent conditions is an important public health intervention strategy. It may be designed to be compulsory or voluntary depending on the epidemiological characteristics of the disease. Integrated screening, including for both syphilis and cancer of the cervix, is a core component of the national reproductive health program in Kenya. Screening for syphilis is compulsory while it is voluntary for cervical cancer. Participants’ perspectives of either form of screening approach provide the necessary contextual information that clarifies mundane community concerns.

Methods

Focus group discussions with female clients screened for syphilis and cancer of the cervix were conducted to elicit their perspectives of compulsory and voluntary screening. The discussions were audiotaped, transcribed and thematic content analysis performed manually to explore emerging ethics issues.

Results

The results indicate that real ethical challenges exist in either of the approaches. Also, participants were more concerned about the benefits of the procedure and whether their dignity is respected than the compulsoriness of screening per se. The implication is for the policy makers to clarify in the guidelines how to manage ethical challenges, while at the operational level, providers need to be judicious to minimize potential harms participants and families when screening for disease in women.

Conclusions

The context for mounting screening as a public health intervention and attendant ethical issues may be more complex than hitherto perceived. Interpreting emerging ethics issues in screening requires more nuanced considerations of individuals’ contextual experiences since these may be contradictory to the policy position. In considering mounting screening for Syphilis and cervical cancer as a public heal intervention, the community interests and perspectives should be inculcated into the program. Population lack of information on procedures may influence adversely the demand for screening services by the individuals at risk or the community as a collective agent.