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Tag: self-harm

Interprofessional collaboration in hospital care of patients who self-harm

Patients who are treated in hospital for self-harm can sometimes arouse strong emotions in the staff. At the same time, the patients may be dissatisfied with their care, which sometimes involves restrictions and safety measures to prevent self-harm. In addition to such tensions between patients and staff, the healthcare staff is divided into different professions with their own roles and responsibilities. These professional groups may have different perspectives and thus conflicting opinions about what care individual patients should receive. In order for patients to receive good and cohesive care, good interprofessional collaboration is therefore required between, for example, nurses and psychiatrists.

A Swedish interview study examined how nurses and psychiatrists think about their responsibility and autonomy in relation to each other in different situations on the ward. In general, they considered themselves autonomous, they could take their professional responsibility without being influenced by other colleagues. Both groups agreed that psychiatrists had the ultimate responsibility for the patients’ care, and it emerged that the nurses saw themselves as the patients’ advocates. If decisions made by the psychiatrist went against the patient’s wishes, they saw it as their task to explain the patient’s views, even if they did not agree with them.

However, sometimes the scope for action could be affected by decisions made by colleagues. For example, one could experience that the scope for taking responsibility for a patient was reduced if colleagues had already isolated the patient. In other cases, one could experience that colleagues’ decisions increased one’s responsibility, for example if decisions based on ignorance about a patient risked leading to new self-harm that the nurses had to deal with.

An important theme in the interviews was how one could sometimes renunciate some of one’s professional autonomy in order to achieve interprofessional collaboration. The interviewees agreed that one ultimately had to stand united behind decisions and set aside one’s own agendas and opinions. Consensus was considered essential and was sought even if it meant reducing one’s own autonomy and power. Consensus was achieved through discussions in the team where participants humbly respected each other’s professional roles, knowledge and experiences.

In their conclusion, the authors emphasize that the study shows how nurses and psychiatrists are prepared to set aside hierarchies and their own autonomy in order to achieve collaboration and shared responsibility in the care of patients with self-harm. Since this has not been visible in previous studies, they suggest that attitudes and skills towards interprofessional collaboration may have improved. As this is essential for good cohesive care of patients, it is important to continue to support such attitudes and skills.

If you want to see all the results from the interview study and read the authors’ discussion about responsibility and autonomy in interprofessional collaboration, you can find the article here: Navigating consensus, interprofessional collaboration between nurses and psychiatrists in hospital care for patients with deliberate self-harm.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Löfström, E. et al. (2025) ‘Navigating consensus, interprofessional collaboration between nurses and psychiatrists in hospital care for patients with deliberate self-harm’, Journal of Interprofessional Care, 39(3), pp. 479–486. doi: 10.1080/13561820.2025.2482691

This post in Swedish

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Longer hospital stays can worsen self-injurious behaviour

Can a hospital stay make the disease worse? It sounds paradoxical, but of course it can occur as a result of, for example, misdiagnosis and negligence, or of overtreatment. When it comes to psychiatric illnesses and ailments, which are often sensitive to the interaction with the environment, it can be difficult to see how the situation at the hospital affects the illness. Therefore, it is important to be attentive.

A new study by Antoinette Lundahl, carried out together with Gert Helgesson and Niklas Juth, draws attention to the problem in the care of patients who self-harm. They did a survey with healthcare staff at psychiatric clinics in Stockholm. The respondents answered questions about experiences of care longer than a week with this patient group. A majority of the respondents believed that it had detrimental effects on self-injurious behaviour if the patients stayed longer than a week in their ward. They also considered that the patients often stayed too long in the ward and that the reasons for the extended length of stay were in several cases non-medical.

How are we to understand this? How might hospitalization increase the risk of the behaviour to be treated? In the discussion part of the article, various possible explanations are suggested, for example conflicts on the ward or that patients spread self-injurious behaviours to each other. Another possible explanation is that the hospital stay is used by the patient to transfer responsibility for handling painful feelings and thoughts to others. Such avoidance strategies only have a short-term effect and increase the pain in the long term. The self-injurious behaviour can be reinforced as a way to get more care and attention. A kind of “care addiction” develops in the patient, you could say.

How should we understand the extended hospital stays? The respondents mentioned several non-medical reasons, such as uncertainty about the patient’s housing, or that patients who look fragile or are assertive influence the staff to extend the length of care. Another reason for extended care times was assumed to be doctors’ fear of being held responsible for suicide or attempted suicide after discharge, a fear which paradoxically could increase the risk.

Read Antoinette Lundahl’s article here: Hospital staff at most psychiatric clinics in Stockholm experience that patients who self-harm have too long hospital stays, with ensuing detrimental effects.

Then you can also read more about the respondents’ suggestions for improvements, such as giving patients clear care plans with fixed discharge dates, short treatment times (a few days), and information about what is expected of them during the hospital stay. Better collaboration with outpatient care was also recommended, as well as more non-medical treatments in inpatient care.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Antoinette Lundahl, Gert Helgesson & Niklas Juth (2022) Hospital staff at most psychiatric clinics in Stockholm experience that patients who self-harm have too long hospital stays, with ensuing detrimental effects, Nordic Journal of Psychiatry, 76:4, 287-294, DOI: 10.1080/08039488.2021.1965213

This post in Swedish

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