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Examining the disciplinary process in nursing a case study approach

Published online 2015 Nov 25. For permission to use where not already granted under a licence please go to http: Abstract Objective It is known that doctors who receive complaints may have feelings of anger, guilt, shame and depression, both in the short and in the long term.

This might lead to functional impairment. Less is known about the impact of the disciplinary process and imposed measures. Previous studies of disciplinary proceedings have mainly focused on identifying characteristics of disciplined doctors and on sentencing policies.

Therefore, the aim of this study is to explore what impact the disciplinary process and imposed measures have on healthcare professionals. Design Semistructured interview study, with purposive sampling and inductive qualitative content analysis. Participants 16 healthcare professionals 9 medical specialists, 3 general practitioners, 2 physiotherapists and 2 psychologists that were sanctioned by the disciplinary tribunal. Results Professionals described feelings of misery and insecurity both during the process as in its aftermath.

Furthermore, they reported to fear receiving new complaints and provide care more cautiously after the imposed measure. Factors that may enhance psychological and professional impact are the publication of measures online and in newspapers, media coverage, the feeling of treated as guilty before any verdict has been reached, and the long duration of the process. Conclusions This study shows that the disciplinary process and imposed measures can have a profound psychological and professional impact on healthcare professionals.

Although a disciplinary measure is meant to have a corrective effect, our results suggest that the impact that is experienced by professionals might hamper optimal rehabilitation afterwards.

The case study approach

Therefore, organising emotional support should be considered during the disciplinary process and in the period after the verdict. A good response rate was achieved, considering the sensitive topic. The study population might be subjected to selection bias.

Background In the past decades, patient safety has gained considerable attention and the importance of addressing medical incidents has been increasingly recognised. Countries differ in their system of disciplinary proceedings. In the Netherlands, disciplinary law is embedded in the Healthcare Professionals Act and applies to eight regulated healthcare professions: It should improve the quality of healthcare and enhance public trust in the medical profession.

Healthcare professionals can be disciplined with a warning, a reprimand, a monetary fine, a conditional suspension, deprivation of the right to perform certain procedures or of the right to re-registration in case a professional voluntarily unregistersor removal from the register. For all other measures, however, the professional is expected to proceed with or return to a subset of his or her activities.

It is known that doctors who receive complaints may have feelings of anger, guilt, shame and depression, both in the short and in the long term. Previous studies of disciplinary proceedings have mainly focused on identifying characteristics of disciplined professionals and on sentencing policies. Methods To answer our research question, we have chosen to perform semistructured interviews since this is an appropriate method to explore people's experiences and attitudes.

We interviewed 16 healthcare professionals that were confronted with a disciplinary measure. To select these professionals, we used a list of all healthcare professionals on whom disciplinary measures have been imposed. Since July 2012, this list is publicly available on the website of the organisation that regulates the Dutch licences. It includes all imposed measures except warnings and monetary fines on healthcare professionals of the eight legally registered professions https: We used data from 1 July 2012 until 28 March 2014.

Participant selection In total, 211 professionals were listed in the file. These concerned 87 examining the disciplinary process in nursing a case study approach, 31 nurses, 21 dentists, 16 healthcare psychologists, 13 psychotherapists, 11 physiotherapists and 3 midwives. No pharmacists were present on the list.

Since the different professions were unequally represented, we aimed to include a proportional mix of healthcare professionals with a minimum of one per profession by purposive sampling. When no one within a profession was eligible for the study or willing to participate, we tried to include more professionals from other professions. Professionals were excluded if the specific events that led to the imposed measure took place abroad, or if the contact details of the professional could not be apprehended.

Thirty-four healthcare professionals were invited for an interview by letter in which a clear description of the study and an outline of the interview were provided. Also, the process of member check and anonymity were described. Professionals that did not respond were phoned up to five times as a reminder. Sixteen professionals indicated they were willing to participate in the study, whereas 12 did not want to cooperate and 6 did not respond. Main reasons for not participating were that the professional wanted to leave the past behind or did not want to recall the specific events.

Interviews In order to answer the research questions, an inventory of possible themes to explore with the interviewees was made based on the current literature and a brainstorm with three researchers LMV, SW and RBK. The third researcher RBK commented on this. After two interviews, the interview guide was adapted on some details.

This paper focuses on the latter, and does not include specific information of each case. This was done to ensure anonymity of the participants and because there was great variation in the events that led examining the disciplinary process in nursing a case study approach the measure and the ability of the interviewees to reflect on these events.

One researcher performed the interviews LMV. The interviewer was female and had experience and training in performing interviews. No relationship was established with interviewees prior to the study. Field notes were made during the interview. All interviews were recorded and transcribed verbatim. Interviewees gave permission to use the anonymous interview report for analysis.

Analysis In this study, we used inductive qualitative content analysis in which we explored themes and categories that emerged from the data. This analysis was done using Atlas-ti V. A codebook was developed based on this inductive analysis. They discussed differences until consensus was reached, and if necessary, the codebook was adapted.

Remaining interviews were coded by one of the two researchers, and checked by the other researcher. Discrepancies were discussed until consensus was reached. Results, progress and data saturation were discussed during the process. Setting In the Netherlands, there are five disciplinary law tribunals.

Any person who has been in the care of a healthcare professional either as a patient or as a patient's relative can file a complaint. Next to this, the Dutch healthcare inspectorate can file complaints. When the tribunal receives a complaint, it first assesses the nature of the complaint. If the complaint is found to be inadmissible, it is rejected. When the complaint is accepted, a public hearing takes place.

The complainant and defendant are not obliged to be present at the hearing, however, in court both parties get the opportunity to clarify their views and answer the questions of the tribunal. After this, the tribunal will deliberate and make a decision. After a tribunal verdict, it is possible for the complainant and the defendant to file a high appeal at the central disciplinary tribunal.

The complete process takes approximately 9 months on average, with a high appeal taking an extra year on average.

Factors leading to disciplinary action against nurses in New Zealand: A case analysis.

In 1995, 792 complaints were filed. In 2013, this number was more than doubled to 1640 complaints, of which approximately two-third concern physicians.

Therefore, we decided to stop further recruitment of participants. The 16 participating professionals included 12 physicians 9 medical specialists, 3 general practitioners2 physiotherapists and 2 healthcare psychologists. Four of them were working in a solo practice, six with colleagues in a group practice and six were employed in an organisation.

Thirteen professionals were men and three women. The imposed measures included 12 reprimands, 1 suspension and 3 removals from the register.

Reasons for these measures included the provision of substandard care, incorrect diagnosis, inappropriate behaviour towards patients, and breach of confidentiality. All verdicts took place more than 6 months before the interview and most cases were concluded not longer than 2 years prior to our study. On average, interviews lasted 1 h. There was great variety in the way the professionals reflected on the events. Some healthcare providers blamed everything that had happened on themselves.

Several professionals felt that they were treated unfairly or questioned the methods, expertise examining the disciplinary process in nursing a case study approach judgement of the disciplinary board. Psychological impact The analysis of the interviews showed that a disciplinary measure and the process around it can have a huge impact on healthcare professionals. On a personal level, the period may leave a deep impression, although some professionals indicated that the impact of the process on their emotional well-being was limited.

Several professionals indicated that they felt insecure, powerless and sometimes even depressed during the disciplinary process. Also, the treatment during the hearing of the disciplinary board was a negative experience for several interviewees.

For example, one professional felt to be treated as guilty during the disciplinary process. These negative feelings were not limited to the disciplinary process, but for some endured long after the process had come to an end, with some experiencing sleepless nights and reliving the disciplinary process for a year after it concluded.

Some professionals indicated to have sought counselling or psychological help after the disciplinary process. Furthermore, some professionals felt threatened by the patient and their family during the process. Several professionals were afraid for new complaints after the process had ended.

  1. Psychological impact The analysis of the interviews showed that a disciplinary measure and the process around it can have a huge impact on healthcare professionals.
  2. Ann Fam Med 2011;9.
  3. The focus for this research is a compassionate analysis of the often complex personal, professional and institutional factors that contribute to situations where nurses fail to exercise the judgement necessary to practice professionally.

Some stated that their colleagues experienced these feelings as well. Box 1 presents an overview of quotes from the interviews, related to psychological impact.

  • Multi-site, mixed method collective case study;
  • In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls ,[ 9 ] the case study approach lends itself well to capturing information on more explanatory 'how', 'what' and 'why' questions, such as 'how is the intervention being implemented and received on the ground?

It gets you down and almost makes you depressed, although you get over it as well. It's the impression I had from the moment I walked in [the disciplinary hearing], just by the way they treated me. I was thinking about what that man the complainant would do. He was delusional and had developed paranoid delusions about his treatment.

What was he going to do at the moment I walked outside alone?