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  • 1.
    Pelto-Piri, V.
    et al.
    Psychiatric Research Centre, Örebro County Council / Örebro University.
    Engström, Karin
    Örebro University.
    Engström, I.
    Psychiatric Research Centre, Örebro County Council / Örebro University.
    The ethical landscape of professional care in everyday practice as perceived by staff: A qualitative content analysis of ethical diaries written by staff in child and adolescent psychiatric in-patient care2012In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 6, article id 18Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Although there has been some empirical research on ethics concerning the attitudes and approaches of staff in relation to adult patients, there is very little to be found on child and adolescent psychiatric care. In most cases researchers have defined which issues are important, for instance, coercive care. The aim of this study was to provide a qualitative description of situations and experiences that gave rise to ethical problems and considerations as reported by staff members on child and adolescent psychiatric wards, although they were not provided with a definition of the concept.

    METHODS:

    The study took place in six child and adolescent psychiatric wards in Sweden. All staff members involved with patients on these wards were invited to participate. The staff members were asked to keep an ethical diary over the course of one week, and data collection comprised the diaries handed in by 68 persons. Qualitative content analysis was used in order to analyse the diaries.

    RESULTS:

    In the analysis three themes emerged; 1) good care 2) loyalty and 3) powerlessness. The theme 'good care' contains statements about the ideal of commitment but also about problems living up to the ideal. Staff members emphasized the importance of involving patients and parents in the care, but also of the need for professional distance. Participants seldom perceived decisions about coercive measures as problematic, in contrast to those about pressure and restrictions, especially in the case of patients admitted for voluntary care. The theme 'loyalty' contains statements in which staff members perceived contradictory expectations from different interested parties, mainly parents but also their supervisor, doctors, colleagues and the social services. The theme 'powerlessness' contains statements about situations that create frustration, in which freedom of action is perceived as limited and can concern inadequacy in relation to patients and violations in the workplace.

    CONCLUSIONS:

    The ethical considerations described by child and adolescent psychiatric care staff are multifaceted and remarkably often concern problems of loyalty and organization. These problems frequently had a considerable influence on the care provided. It seems that staff members lack a language of ethics and require both an ethical education and a forum for discussion of ethical issues.

  • 2.
    Stickley, Andrew
    et al.
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). London School of Hygiene and Tropical Medicine.
    Koyanagi, Ai
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Koposov, Roman
    McKee, Martin
    Roberts, Bayard
    Ruchkin, Vladislav
    Peer victimisation and its association with psychological and somatic health problems among adolescents in northern Russia2013In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 7, no 1, article id 15Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A growing body of evidence from countries around the world suggests that school-based peer victimisation is associated with worse health outcomes among adolescents. So far, however, there has been little systematic research on this phenomenon in the countries of the former Soviet Union. The aim of this study was to examine the relation between peer victimisation at school and a range of different psychological and somatic health problems among Russian adolescents.

    METHODS: This study used data from the Social and Health Assessment (SAHA) - a cross-sectional survey undertaken in Arkhangelsk, Russia in 2003. Information was collected from 2892 adolescents aged 12-17 about their experiences of school-based peer victimisation and on a variety of psychological and somatic health conditions. Logistic regression analysis was used to examine the association between victimisation and health.

    RESULTS: Peer victimisation in school was commonplace: 22.1% of the students reported that they had experienced frequent victimisation in the current school year (girls - 17.6%; boys - 28.5%). There was a strong relationship between experiencing victimisation and reporting worse health among both boys and girls with more victimisation associated with an increased risk of experiencing worse health. Girls in the highest victimisation category had odds ratios ranging between 1.90 (problems with eyes) and 5.26 (aches/pains) for experiencing somatic complaints when compared to their non-victimised counterparts, while the corresponding figures for boys were 2.04 (headaches) and 4.36 (aches/pains). Girls and boys who had the highest victimisation scores were also 2.42 (girls) and 3.33 (boys) times more likely to report symptoms of anxiety, over 5 times more likely to suffer from posttraumatic stress and over 6 times more likely to experience depressive symptoms.

    CONCLUSION: Peer victimisation at school has a strong association with poor health outcomes among Russian adolescents. Effective school-based interventions are now urgently needed to counter the negative effects of victimisation on adolescents' health in Russia.

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