{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:10:16Z","timestamp":1789017016180,"version":"build-2803163510"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p>Psychiatric inpatient care for individuals who engage in self-injury involves tensions between preventing harm, respecting autonomy, sustaining relational care, and managing organizational demands. Staff may experience emotional burden and moral distress, while patients may experience care as invalidating, coercive, or insufficiently responsive to their needs. This article develops a theory-informed conceptual framework applying Albert Bandura's theory of moral disengagement to psychiatric inpatient care for self-injury. Drawing on an interpretive synthesis of Bandura's theory and clinical literature identified through a focused, non-systematic search, it examines how moral disengagement-related processes may shape the interpretation, justification, and normalization of problematic care practices. The framework maps Bandura's eight moral disengagement mechanisms across four loci of moral self-regulation: conduct, agency, consequences, and recipients. It illustrates how practices may be interpreted as protective, reframed through euphemistic language, or made acceptable through comparison with more severe alternatives. Responsibility may be displaced onto institutional authority or diffused across teams, while the interpersonal and psychological consequences of care may be minimized or treated as secondary to immediate safety demands. At the recipient locus, patients may be dehumanized through reduction to diagnoses, risk profiles, or behavioral categories, or blamed for their self-injury and for the emotional and organizational burdens associated with care. The framework situates these mechanisms within a recursive multilevel process in which staff appraisals, care practices, patient responses, and team and organizational conditions may mutually shape one another over time. The analysis is conceptual and hypothesis-generating, not an empirical demonstration that moral disengagement has occurred in specific situations. Rather than locating problematic care primarily in individual failure, the framework directs attention to the relational, organizational, and societal conditions under which ethical responsiveness may be weakened or restored. Future research should operationalize these processes and examine them across staff and patient perspectives and individual and collective levels.<\/jats:p>","DOI":"10.3389\/fpsyg.2026.1900173","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:33:00Z","timestamp":1789014780000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Moral disengagement in psychiatric inpatient care for individuals who engage in self-injury: a conceptual framework for understanding staff responses and patient experiences"],"prefix":"10.3389","volume":"17","author":[{"given":"Jonas","family":"Bj\u00e4rehed","sequence":"first","affiliation":[{"name":"Department of Psychology, Lund University","place":["Lund, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Bj\u00e4rehed","sequence":"additional","affiliation":[{"name":"Faculty of Education, Kristianstad University","place":["Kristianstad, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12968\/bjmh.2020.0006","article-title":"Staff attitudes, beliefs and responses towards self-harm: a systematised literature review","volume":"11","author":"Akinola","year":"2022","journal-title":"Br. J. Ment. Health Nurs."},{"key":"B2","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1207\/s15327957pspr0303_3","article-title":"Moral disengagement in the perpetration of inhumanities","volume":"3","author":"Bandura","year":"1999","journal-title":"Pers. Soc. Psychol. Rev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1080\/0305724022014322","article-title":"Selective moral disengagement in the exercise of moral agency","volume":"31","author":"Bandura","year":"2002","journal-title":"J. Moral Educ."},{"key":"B4","volume-title":"Moral Disengagement: How People Do Harm and Live With Themselves","author":"Bandura","year":"2016"},{"key":"B5","doi-asserted-by":"publisher","first-page":"17","DOI":"10.20299\/jpi.2022.005","article-title":"Exploring experiences of restrictive practices within inpatient mental healthcare from the perspectives of patients and staff","volume":"18","author":"Bendall","year":"2022","journal-title":"J. Psych. Intensive Care"},{"key":"B6","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1111\/jpm.12129","article-title":"Safewards: a new model of conflict and containment on psychiatric wards","volume":"21","author":"Bowers","year":"2014","journal-title":"J. Psychiatr. Ment. Health Nurs."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e178","DOI":"10.1192\/bjo.2022.574","article-title":"Patients' and staff members' experiences of restrictive practices in acute mental health in-patient settings: systematic review and thematic synthesis","volume":"8","author":"Butterworth","year":"2022","journal-title":"BJPsych Open"},{"key":"B8","first-page":"62","article-title":"Dialectical behavior therapy: current indications and unique elements","volume":"3","author":"Chapman","year":"2006","journal-title":"Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","first-page":"S183","DOI":"10.1192\/bjo.2021.496","volume":"7","author":"Davies","year":"2021","journal-title":"BJPsych Open"},{"key":"B10","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1177\/0969733015574924","article-title":"Nurse moral disengagement","volume":"23","author":"Fida","year":"2016","journal-title":"Nurs. Ethics"},{"key":"B11","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1177\/2374373518800811","article-title":"\u201cVoluntarily admitted against my will\u201d: patient perspectives on effects of, and alternatives to, coercion in psychiatric care for self-injury","volume":"6","author":"Gerle","year":"2019","journal-title":"J. Patient Exp."},{"key":"B12","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1002\/ab.21502","article-title":"Moral disengagement among children and youth: a meta-analytic review of links to aggressive behavior","volume":"40","author":"Gini","year":"2014","journal-title":"Aggress. Behav."},{"key":"B13","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1080\/09638237.2025.2478372","article-title":"Service users' experiences of restrictive practices in adult inpatient mental health services. A systematic review and meta-ethnography of qualitative studies","volume":"34","author":"Griffin","year":"2025","journal-title":"J. Ment. Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1111\/j.1447-0349.2011.00794.x","article-title":"Self-harm and attempted suicide within inpatient psychiatric services: a review of the Literature","volume":"21","author":"James","year":"2012","journal-title":"Int. J. Ment. Health Nurs."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1177\/0969733019877526","article-title":"Moral distress in acute psychiatric nursing: multifaceted dilemmas and demands","volume":"27","author":"Jansen","year":"2020","journal-title":"Nurs. Ethics"},{"key":"B16","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1111\/jpm.12171","article-title":"Nurses' attitudes towards self-harm: a literature review","volume":"22","author":"Karman","year":"2015","journal-title":"J. Psychiatr. Ment. Health Nurs."},{"key":"B17","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1177\/09697330241238336","article-title":"Moral disengagement, moral identity, and counterproductive work behavior among emergency nurses","volume":"32","author":"Ke","year":"2025","journal-title":"Nurs. Ethics"},{"key":"B18","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s12910-025-01282-6","article-title":"Moral disengagement in critical care nurses: a conventional content analysis","volume":"26","author":"Khanipour-Kencha","year":"2025","journal-title":"BMC Med. Ethics"},{"key":"B19","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1002\/ab.21833","article-title":"A meta-analysis of the relationship between moral disengagement and bullying roles in youth","volume":"45","author":"Killer","year":"2019","journal-title":"Aggress. Behav."},{"key":"B20","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1080\/13811118.2017.1319309","article-title":"A systematic literature review of experiences of professional care and support among people who self-harm","volume":"22","author":"Lindgren","year":"2018","journal-title":"Arch. Suicide Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1080\/13561820.2025.2482691","article-title":"Navigating consensus: interprofessional collaboration between nurses and psychiatrists in hospital care for patients with deliberate self-harm","volume":"39","author":"L\u00f6fstr\u00f6m","year":"2025","journal-title":"J. Interprof. Care"},{"key":"B22","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1177\/1049732319886566","article-title":"Patients' experiences of emergency hospital care following self-harm: systematic review and thematic synthesis of qualitative research","volume":"30","author":"MacDonald","year":"2020","journal-title":"Qual. Health Res."},{"key":"B23","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1521\/jscp.2006.25.2.141","article-title":"Mechanisms of moral disengagement in support of military force: the impact of Sept. 11","volume":"25","author":"McAlister","year":"2006","journal-title":"J. Soc. Clin. Psychol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.copsyc.2015.07.018","article-title":"Moral disengagement","volume":"6","author":"Moore","year":"2015","journal-title":"Curr. Opin. Psychol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/s10551-019-04173-0","article-title":"Moral disengagement at work: a review and research agenda","volume":"167","author":"Newman","year":"2020","journal-title":"J. Bus. Ethics"},{"key":"B26","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1111\/j.1467-8721.2009.01613.x","article-title":"Why do people hurt themselves?: new insights into the nature and functions of self-injury","volume":"18","author":"Nock","year":"2009","journal-title":"Curr. Dir. Psychol. Sci."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1111\/jpm.13077","article-title":"\u2018Throw me a life buoy, please': a systematic review and thematic synthesis of qualitative evidence regarding nurses' experiences of caring for inpatients with borderline personality disorder and\/or non-suicidal self-injury","volume":"31","author":"Nordkamp","year":"2024","journal-title":"J. Psychiatr. Ment. Health Nurs."},{"key":"B28","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1111\/papt.12113","article-title":"Hospital staff experiences of their relationships with adults who self-harm: a meta-synthesis","volume":"90","author":"O'Connor","year":"2017","journal-title":"Psychol. Psychother."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s10551-026-06312-w","article-title":"The emergence of collective moral disengagement","author":"Schaefer","year":"2026","journal-title":"J. Bus. Ethics"},{"key":"B30","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1111\/inm.12966","article-title":"Women's experiences of restrictive interventions within inpatient mental health services: a qualitative investigation","volume":"31","author":"Scholes","year":"2022","journal-title":"Int. J. Ment. Health Nurs."},{"key":"B31","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1177\/10783903221116132","article-title":"Compassion satisfaction and burnout are related to psychiatric nurses' antipathy towards nonsuicidal self-injury (NSSI)","volume":"30","author":"Streeto","year":"2024","journal-title":"J. Am. Psychiatr. Nurses Assoc."},{"key":"B32","doi-asserted-by":"publisher","first-page":"23779608251395004","DOI":"10.1177\/23779608251395004","article-title":"Lived experiences of moral disengagement among intensive care and emergency department nurses: a phenomenological study","volume":"11","author":"Talebian","year":"2025","journal-title":"SAGE Open Nurs."},{"key":"B33","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1192\/bjp.bp.107.046425","article-title":"Attitudes towards clinical services among people who self-harm: systematic review","volume":"194","author":"Taylor","year":"2009","journal-title":"Br. J. Psych."},{"key":"B34","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1111\/jpm.12384","article-title":"How people who self-harm negotiate the inpatient environment: the mental healthcare workers perspective","volume":"24","author":"Thomas","year":"2017","journal-title":"J. Psychiatr. Ment. Health Nurs."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1900173\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:33:08Z","timestamp":1789014788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1900173\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":34,"alternative-id":["10.3389\/fpsyg.2026.1900173"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1900173","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"1900173"}}