What causes deliberate self harm in adolescence - Dissertation Example

?Running head: Deliberate Self-Harm Deliberate Self-Harm in Adolescents This research paper discusses the problem of deliberate self-harm behaviour, concentrating basically on adolescents. Most of the young adults harming their bodies tend to have depressive symptoms; however, some of them also have depressive disorders. Still, in case depression is not cured and neither does it respond to actions, there is an urgent requirement of taking antidepressants. The causes behind adolescents engaging in such destructing behaviour are discussed, some of which include parental neglect, peer victimization, distress, depression, child abuse, sexual abuse and so on, each factor having different importance. The reasons behind deliberate self-harm are also considered of which one is that stressed out subjects feel better after harming their body. At times, however, the self-harm conducted may be so damaging that they may need medical assistance. In such cases many times the nurses attending to such patients develop a very negative attitude towards them which affects the care they offer. This issue has also been discussed and after a literature survey it was found that such is not always the case; acttually it all depends upon the client. There is a definite need to educate medical professionals and provide them with guidelines to better care for such patients. They need to put aside their differences and make sure to attend to these patients like they would attend any other patient. What causes deliberate self-harm in adolescents? Introduction Adolescence is a very important and critical developmental phase during which physical, cognitive and personality features transform a person, from a child to a young adult. Every child goes through different phases in cognitive development. Such cognitive alterations are reflected through the conceptualisation made of death and it begins with an early realisation, as early as the age of 8, that every person has to die one day, through to an existential “choice to live” while an adolescent. Young adults from the West do not judge suicidal behaviours but such is not the case with their parents. This difference can be seen in the way suicide is portrayed by today’s youth. Deliberate self-harm (DSH) behaviour is a critical health issue gaining increasing attention as a clinical phenomenon . It causes harm to the person’s body together with impeding social relations, medical treatment and psychotherapy . According to certain reports such violent activities performed to harm one’s own body indicate extreme psychopathological problems . The reason that adolescents give for hurting their bodies with any kind of a physical object is that self-harm relieves them from emotional distress . Besides, tt is known that self-harm relates to issues like peer victimization, emotional carelessness on the part of the parents, childhood sexual abuse, insecure attachment, anxiety, depression, low self-esteem, body dissatisfaction, scoring low in school, being on drugs, dissociative symptoms, and general psychopathology . The strategy employed for this research paper is secondary research; a survey was conducted of the literature available today. Books and journal articles related to the topic were analysed and relevant ideas were noted. Basically sciencedirect and EBSCO was used and the terms “deliberate self-harm”, “adolescents” and “nurses attitude” were entered in the search engine and the articles that came up were assessed and analysed. Besides that, Google books and scholar was also considered. Sources from the year 1991 onwards were considered but most of the sources were still from the last decade. This made sure that the most recent literature was used in order to ensure the relevance of the material in today’s world. This research paper basically aims at understanding the problem of DSH, especially among adolescents. The reasons and causes behind them engaging in DSH are investigated into and discussed. Besides that the attitude of nurses against such patients is looked into. The general view is that nurses develop an antipathy against such patients but through research it was found that this is not always the case. analysed what the staff went through working with self-harmers in a forensic learning disability service. According to the staff the relationship with self-harming patients went to extremes; it was either too close or too hostile. Still, every relationship had problems regarding the struggle of power, professional limitations and risk versus control. Literature Review There are various definitions of self-harm and the difference between them is the presence or exclusion of behaviours like attempted suicide, self-poisoning, and general self-destructive behaviour. Theoretic opinions have suggested that previous reasons behind and the results that are expected from self-harm have basic differences when compared to those of attempted suicide . have defined self-harm as the “deliberate, direct destruction or alteration of body tissue without conscious suicidal intent but resulting in injury severe enough for tissue damage” (p.250). When considering this description of self-harm researches conducted recently found out through one year estimates that self-harm is 40% prevalent in adolescents of Sweden while in the US the rate stands between 26% to 46% . Since these investigations have taken into consideration the social and ethnic diversity in their community samples that were attained via schools, this kind of a high rate of self-harm begs for more attention than what had been necessary previously. The usual definitions given of DSH behaviour do not take into account suicidal intention . Such is the concept normally considered in the US publications while in the UK the term self-harm does not consider whether the behaviour is suicidal or not, therefore it includes both suicidal and non-suicidal intended self-harm. Due to such a discrepancy there is a limitation present when we compare cross-national study. In the UK the issue of self-harm was first brought to attention in the 1960s and it is still an important health concern till today. According to England and Wales have a rate of 100,000 people harming themselves annually, while the issue of self-mutilation is at one in every fifteen people . A lot of adolescents engaging in the act of DSH tend not to look up to anyone for help. In few cases when they actually do go to someone the person is normally someone from their friends or family and not actual medical professionals. One reason as to why they shy away from asking help is that they feel this is a sign of weakness, or they are not able to admit to having issues out of embarrassment or any other reason . Besides, there exist gender differences among such people and it is noted that the male population of self-harmers tend not to ask for assistance as compared to the women, and they also have more troubles than the females when they do indeed ask for help from their GP . It is difficult to treat adolescents. Certain studies have shown that those adolescents who have attempted suicide have lower rates of being engaged in treatment as compared to those who have not taken such a step. Although it has been tried to increase the number of suicidal adolescents engaged in treatment, the involvements did not succeed as such and, therefore, there is a requirement of new tactics being brought about in order that such a critical problem is resolved . Self-poisoning is a very common way of self-harm; in fact, it is so common that almost 90% of DSH cases that are reported to hospitals are a result of self-poisoning. Mostly the overdoses taken do not really threaten the life of the self-harmer; however, there has been an increasing intake of paracetamol for such purpose and this is troubling because of how it can irreversibly damage the liver. Besides, the means of self-poisoning is more used by females as compared to males. There is not much information available regarding the epidemiology of DSH amongst the adolescents of UK. It is known that there was a mark increase in the rates of referral to hospital during the 1960s-70s. The 1980s saw this incidence being levelled out but there is a possibility of it rising again . From the findings of the WHO/EURO multicentre hospital study of parasuicide it was concluded that the rates of DSH in young adults between the age 15-24 years were the highest in the whole of Europe . Peer Victimization and Deliberate Self-Harm Young adults newly entering the stage of adolescence feel it very important to be accepted among their peers and it is expected that victimization leads to internal distress. When defining peer victimization it is said to be aggressive behaviour by one peer on another in order to hurt the person or to socially dominate over everyone . A lot of literature is present regarding the topic of peer victimization (see ), but there are not many studies which have actually investigated into any kind of a relationship between peer victimization and DSH. Cross-sectionally, it has been considered that there is an association between being bullied and DSH in community-based cross-sectional researches of young adults . There are, however, less consistent results regarding any kind of a lasting effect of peer victimization upon self-harm. A two year study by found that there is no relationship between peer victimization and later self-harm, while found in a 3 year follow up study that there was indeed an association between the two. Nevertheless, because the study they performed had no control for continuity of the study variables over time it is not clear if ’s study actually does indicate a truly predictive association between the two. Parenting and Deliberate Self-Harm A variety of characteristics of parenting have been termed as being risk factors for DSH occurring within dysfunctional families. These may include pathological family relationships , insecure attachment , and physical and sexual childhood abuse . Still, there is only limited empirical literature present which addresses negative parenting behaviours as being causes behind DSH. This area has attracted very little attention and just a couple of studies have been conducted in regard to this; two of these have distinguished conflictual parent-adolescent relations as having relevance to DSH among adolescents . A community-based cross-sectional research of adolescents had been conducted recently and it found out that self-harm had an association with fear that may be a result of lack of care on the part of the parents . Invalidating family environments , poor adolescent-parent communication , and parental neglect of sadness have been related to DSH. These researches indicate aggressive verbal and nonverbal behaviour on the part of the parents having a major influence on their children engaging in DSH, there have not actually been studies conducted across an extended period of time. Emotional Regulation and Deliberate Self-Harm According to the experiential avoidance model the adolescents who cannot properly cope with emotional distress and regulate behavioural impulses are likely to display a strong relation between interpersonal stress and DSH . Theoretical and empirical work is present which asserts that DSH works as a means through which stress can be reduced , and researchers have given proper attention to the dysfunctional characteristic of emotion regulation, giving reference to the control of non-adaptive behaviours while undergoing stress. If there is no emotion dysregulation that would still not mean an implication of an optimal approach toward negative feelings. Thus, there is more precision involved in an adaptive-integrative aspect of regulation feelings, and this concerns with the awareness, acceptance and verbalisation of intense emotions and also constructive problem solving. Even though the experiential avoidance model keeps into consideration the different definitions of emotion regulation, it looks like, on one hand, the previous theoretical and empirical research recognises uncontrollable expressions of effect, and on the other the comprehension and recognition of emotions as is specifically applicable to clarifications for engaging in DSH. Just like emotion dysregulation, impulsivity has a relation to self-control; however, it has no actual involvement with the ability of efficiently coping with extreme feelings. From research it has been found that intentional self-harm and impulsivity normally takes place together in clinical samples . Large non clinical samples have also found out a relation between impulsivity and DSH . Still, even though the qualitative features of emotion regulation as well as impulsivity have theoretical relevance toward psychological mechanisms behind DSH, there has been actually no study published which might have researched into the probable moderating effects. Summing up, the experiential avoidance model suggests that interpersonal stress can predict how involved an adolescent may be in engaging in DSH. The literature supports the model empirically regarding the cross-sectional and retrospective relationships between DSH and interpersonal stress. Nevertheless, even though predictive as well as moderating relations toward DSH very often are explicitly suggested theoretically and empirically, it is rare that they are tested across time . Therefore, till now there has not been any actual conclusion to whether such implications would be supported through probable two-wave longitudinal study which controls for temporal as well as concurrent co-variation. Correlations and Risk Factors DSH behaviours may be prevalent at all ages. However, it is among the adolescents and young adults that especially high rates are found . Also, a higher association of DSH was found to be present in adolescents having low level of education . Besides, from probable data it was revealed that unemployment and no partnership can be a predictive factor behind recurrence of DSH within a year . There are very many studies conducted on the issue of DSH and these have investigated into the stressful traumatic involvements during childhood. Almost all studies have found relations with DSH behaviour. Among the factors the following are the most important and usual ones: psychological problems from the side of a parent, parental separation, and early or prolonged separation from a parent. Very often relations were found between emotional neglect experienced during childhood, psychological or physical abuse, more specifically sexual abuse, and adolescent or adult self-harm behaviour. Those engaging in the practise of self-harm tend to more frequently experience negative feelings in their lives compared to those who stay away from such a habit. Therefore, it is probable that too much of negative feelings are what may be causing DSH since self-harm has some kind of an ability of alleviating emotional distress. and have suggested that the reason behind people harming themselves on purpose is to bring about pain since that helps them in releasing the stress and emotions bottled up inside them. Not everyone is able to fully express and show what their emotions; they are not able to speak out their feelings, and therefore, they turn to self-harm. has termed the consequences of self-harm as being “inner scream”. Arnold and Magill (2000) has said that the consequence of self-harm is basically the means through which help is asked for while explains it being a cry for help and the means through which such people can cope with others. has explained self-mutilation as an intimidating obstacle which prevents us from seeing a person who might have gone astray, might be in pain and needing assistance. Although self-harm is such a serious issue and these kinds of clarifications are provided to explain it, there are still certain health professionals who term it as attention-seeking . Besides, a certain relation is also present between supposed health issues and DSH. The facts discovered of these psychopathological aspects seem to be particularly related to self-harm – like derealisation/dislocation or alexithymia/not being able to express emotions – and are good but only correlatively. Those who are self-harmers face more problems in understanding or recognising and even expressing their emotions than the people who do not harm themselves . Through one study a relation was found between too much stress in the last month and DSH behaviour ; nevertheless, there had not been any assessment of time in the study. Another study has linked self-harm behaviour to critical life events, and in this research measurement of these two factors was done retrospectively for the previous year. In this too, however, there was no assessment of any time sequence. According to certain cross-sectional findings there have an indication of a link between lower personal coping resources and DSH. Many studies found that those having low self-esteem and not being able to solve problems are more liable towards DSH behaviour; they also did not believe in self-efficacy and tended to blame their own selves , to derogate themselves . Response from Nurses Assessing self-harm happens to be among the most important clinical responsibilities on the part of mental health services. Recently, there are several hospitals of the UK that have reconfigured such services into nurse-led teams instead of persisting with the preparations founded upon rosters of trainee psychiatrists. These kinds of strategies are being provided guidance from professional guidelines – however, they had been supported by weak evidence. Initially when the issue of self-harm was first brought up the governmental health departments of the UK suggested that the persons who self-harm need to be admitted to a medical ward after which a psychiatrist should assess them prior to them being discharged. However, later on in the 1970s research revealed that even the doctors having no training in psychiatry, social workers and nurses all had the ability of carrying out these kinds of assessments. The UK guidance was then changed taking into consideration this research and it was allowed for all professionals to conduct those assessments if they were trained, supervised and had spare time. Since many years the clients are being assessed in several hospitals and the social workers and mental health nurses are the ones assessing them. After such changes took place in clinical practice, there were several researches conducted that put forward a comparison between the work by the trainee psychiatrists and mental health nurses; however, such comparisons had not examined the consequences anyhow. A lot of evidence exists for the fact that those who engage in activities of self-harm do go through negative attitudes that the health professionals say to be evident in reports by service users, those who observe the attitudes of the nurses, and the nurses themselves as well . There are several elements contributing to making the dynamics of tackling self-harm complicated and they work up to make it a challenge when attempt is being made to attain therapeutic engagement. A very important element that has an influence upon behaviour happens to be self-inflicted nature of the harm but there are several other elements including aversesiveness of certain damage caused and the fact of repeating the act in certain kinds of self-harm behaviour . There will be variation in the experience of the patient and the depending factor of that is the environment wherein they are receiving care. The service provided by the Emergency Department is not enough and the staff is certainly not committed to providing proper mental health care neither do they actually focus upon healing the damage the patient may have caused to his body. On the other hand, however, the inpatient unit cares more for the patient and its staff who has worked for a longer duration with the client shows more commitment toward them, more particularly regarding the mental health problems . This remains unrealized. Certain mental health staff does not tolerate self-harm behaviour at all and there are some who have a prejudice against them and thus develop negative attitude toward them in the event of being repeatedly faced by such clients. According to the medical professionals do not simply positively or negatively look at such cases; instead there remain various aspects to their attitudes and these depend upon the client they are looking after. Another view is that the nurses who are extremely antipathetic towards self-harm are professionally not good; this assumption is wrong. There is still a need to properly understand and explore the inferences for behaviour of the differing attitude dimensions. When a research is being conducted regarding this issue and the participants are filling out the questionnaire it is quite obvious that they have to generalize their experiences and attitudes of antipathy toward self-harming clients; however, say that caution needs to be practiced and a safe assumption cannot be made that every nurse is always antipathetic toward such patients; rather, their behaviour actually depends upon the client’s own behaviour. There are several studies out there investigating into the issue of self-harm or suicide who concentrate upon the behaviour of the individuals but there is still not enough clarity regarding the degree to which the behaviour of people can be seen through the attitude that a care team holds. There is no clear understanding regarding the effect that the quality of antipathy in nurses may have upon the patients; that is, whether more empathic therapeutic relationship with them might better the influence of antipathy in a worker. The nurses working at the emergency department in hospitals play a main role in showing great care to the patients who have self-harmed themselves, but certain reports show that some of the nurses display unfavourable mannerisms towards the patients. This is worrying since there is a strong bond connecting self-harm and suicide. The place where the DSH patients first contact is the emergency department. All nurses, specifically the triage nurses, are needed when detecting DSH and showing care as required, but a majority thinks that they are properly prepared to consider their patients suffering from mental health issues . This lack of believe in self emphasizes on the negative approach which the nurses show towards the patients and they then feel that they are not their main concerns . The health care professionals are unsure regarding their feelings towards the patients who harm themselves. They perceive them to be troublesome or seeking attention . The professionals may not understand their patients’ reasons of harming themselves nor do they have the required skills needed to take care of these individuals . It is quite a conundrum since the nurses of the emergency department believe that self-harming patients should be looked after by the mental health nurses but the latter find themselves not trained to be working in the emergency departments (Multicultural Mental Health Australia 2000). The nurses may start displaying negative attitudes due to a variety of reasons. Encountering and dealing with the suicide of their patient and having no emotional support can result in them feeling guilty, shameful and thinking of themselves as failures. carried out an organized evaluation of the attitudes of the health professionals and their patients’ views on the ‘inappropriate’ emergency department attendances. He discovered that bad attitudes may result in the nurses, who though their work to be too time-consuming and not as rewarding, to be taking less care of their patients. The observations of the patients who have experienced the emergency departments seem to reveal the negative attitudes they may hold. A study carried out in one of the main hospitals in Brisbane, Australia, shows that of all the hospital’s young patients suffering from DSH, only a little less than half claimed the emergency department workers to be helpful or concerned whilst the other one-third found the staff to be useless . Similar comments have been said of the hospital staff in the UK. carried out an investigation in Northern Ireland about the attitudes of the emergency department nurses towards the patients. He discovered that the attitudes of the older and experienced nurses were complimentary than of the younger and less practiced ones. Likewise, study shows that the encouraging attitudes of the emergency nurses of the mental health towards the patients having suicidal behaviour resulted in an increase in their age and a longer clinical experience. On the other hand, ’s study of the emergency department staff in Queensland, Australia discovered no important relationship between the lengths of the clinical experiences of the patients and their attitudes to self-harming themselves. This gives the conclusion that the approach towards self-harm is complex as well a multidimensional. Literature has pointed out the fact that self-harming patients who attend accident and emergency departments even for purposes beside self-harm are perceived in a negative manner, and after it is known that a person is a self-harmer the reason behind their admittance to hospital is not regarded. In his research went around interviewing several medical professionals through whom he found that the self-harmers are looked at in a negative manner and that they are only asking for attention. From the interviews that conducted of the nurses working in a Medical Admission Unit it was found that these nurses felt indignant and irritated against those who engaged in self-harm activities and the implication made was that such kinds of attitudes would negatively affect the relationship between the nurses and their patients. From the research of it was found that the patients had a feeling that the medical professionals did not understand them and the care they received from them was even termed “hostile”. Besides all these issues, it is difficult to treat adolescents. Certain studies have shown that those adolescents who have attempted suicide have lower rates of being engaged in treatment as compared to those who have not taken such a step. Although it has been tried to increase the number of suicidal adolescents engaged in treatment, the involvements made led to no such success and, therefore, there is a requirement of new tactics being brought about in order that such a critical problem can be resolved . Seeing that the negative attitudes of the nurses badly affect the care provided to the self-harmers, attempts have been carried out to improve their manners towards the patients. Suitable training as well as support is required, the prescribed assessment protocols need to be properly executed and the medical guidelines of how to care for the patients suffering from DSH. In particular, education is shown to play a major role in improving the negative attitudes. Also, it leads to a more superior standard of the psychosocial evaluation of the DSH patients in the emergency. In the Fremantle Hospital in Australia, the skilled mental health staff was taught to triage and also to manage the patients in the emergency department who were suffering from mental problems. Through their first year of operation, they cared for 257 patients suffering from DSH and of all of them only three had another episode of DSH . Taking the connection between DSH and suicide in mind, and that several of these people come to the emergency departments, it is quite necessary to evaluate the mannerisms the nurses show to their patients. Conclusion Some of the aid was found in terms of peer victimization. The experimental evasion model in the interpersonal anxiety showed to have an effect on the adolescents’ participation in intentional self-harm. It appears that instead of going through self-harm and peer victimization as two problems occurring together without any predictive outcome, the likelihood of the adolescents deliberately harming themselves increases as a result of being mistreated by their peers. The consequences regarding peer victimization show implications for theory as well as practice. Firstly, a proper link should be established between peer victimization and the self-harmer. This may raise awareness of the psychological mechanisms which are associated with self-harm. Adolescents account that usually they feel anxiety and hostility before deliberately harming themselves . Research shows that continuous exclusion of a social life results in feeling distressed . The connection found between peer victimization and intentional self-harmers shows what emotions trigger people may be going through which results in them harming themselves. Secondly, the psychological effects which may result due to peer victimization may be quite a lot than generally acknowledged. The consequences support the argument that the environmental stressors in a peer context raise the risk of those harming themselves deliberately. It also shows that the stressors have an effect on the self-harmers when the study controls for the result of harsh parenting . Harsh parenting did not have any important impact on the frequency of the people harming themselves deliberately in this case. Nevertheless, the result indicates that the consequences of harsh parenting are that the girls are more involved in deliberately harming themselves than the boys. There are many justifications why harsh parenting was not an important general predictor of people harming themselves on purpose in this study. For example, this may be because harsh parenting does not lead to the emotional reactions in adolescents, especially the boys, that have significance for self-harm. It has been implied that applying parental verbal aggression commonly may ultimately become a normal behaviour between the parent and the child . This study shows that relative aspects may play a major part for the effect of interpersonal stress on people harming themselves on purpose. Adolescents who are exposed to interpersonal pressure in social circumstances might think the experience to be worrying enough to look for liberation by engaging in harming themselves. But a similar experience in some other context may not achieve that result. There is always a probability that the medical professionals would develop negativity towards DSH but found that staff usually dealt with DSH positively and this was more the case with the ones who had actually had some community and psychological background. The negativity that developed in the others could be explained as ranging from self-recrimination to feelings of failure and loss of confidence and could vary from feelings of guilt, anger, hate, and sympathy. The suggestion made was that the main root of some of such feelings could have been real or imagined responsibility for the patients injuring themselves, or from the powerful countertransferences that are said to be a result of DSH and have a degree of importance in the way the basic psychological functioning of patients is understood. Besides that, there is not enough guidance regarding the way DSH needs to be managed and this turns out to be a major reason behind the primary care nurses not having enough confidence and feeling frustrated. It is being seen that the rates of DSH amongst adolescents of the UK are increasing in spite of the number of deaths going down. Among the various risk factors behind suicidal thinking among the young people some include: depression; substance abuse; sexual and physical abuse; bullying; hopelessness; poor coping; and suicidal behaviour by family and friends and in the media. There was similarity found in the psychiatric symptomatology of the self-harmers even though they were involved in the act in different ways. Just a very small percentage of the young people engaging in DSH behaviour actually report to hospital. There is a requirement on the part of the paediatricians to question the patients regarding any kind of suicidal ideation no matter what the current issue might be with them. Besides, it is the responsibility of the clinicians to not use the means or medical gravity of any kind of DSH behaviour as being an alternative to suicidal intent. Treatment approaches have been analysed by several important researches, and these include CBT (in the presence or absence of fluoxetine) and social support interventions. Guidance has been published on an official level that would allow for improvement in managing patients engaging in DSH behaviour. Recommendation for Practice For an enhanced knowledge, the research held in the future should discover whether self-harm comes only before particular kind of negative feelings such as agitation or aggression. Bearing in mind the dissimilarities in the result of the interpersonal pressure in the family environment on one side, and the peer context on another, upcoming research may study the possible effect of stress coming from different sources on harming themselves on purpose. The experimental evasion model does not show grief preceding the self-harming acts as automatically being an effect of interpersonal stress. But it includes any stimuli which set off experiences of suffering. The test of raising the occurrences of deliberate self-harm insists that we be present at the emotional improvement as well as the psychosocial situation for the children and the adolescents. Information on correlates and the possible risk aspects is vital to predict and understand and treat the people deliberately self-harming themselves better. Many often antipathy may be present in people as an individual, or a team, and when this is the case there is a requirement of helping the staff to attend to the patient in a proper and different way. Such should be the case even when the level of antipathy is low, which means every individual of a staff needs to be trained. How influential such training and education may be to the individuals regarding their attitude to self-harm has been investigated in a previous research . There is definitely a requirement of further training and education for the healthcare workers in this area. This is even more important considering that the true statistics for self-harmers can be achieved just through hospital admissions. This is because many self-harmers may refrain from going to the hospital or seeking any kind of help due to any reason; thus, the real numbers could probably be far more than what might be on record. Although community psychiatric nurses (CPNs) come across and manage DSH very frequently, there is still not enough research conducted regarding what they actually go through while working with such a persisting issue. The kind of treatment and care that those engaging in DSH get is normally dependent to a great degree upon how much the staff actually understands the behaviour and what their response is towards it. It is hoped that with time the nurses would change their attitudes regarding this issue and would become better and be better able to fulfil the requirements of the self-harmers in order that they are able to attain the proper time, treatment and attention that they need. It is very much evident that nurses do tend to neglect their duties regarding such individuals even though there exists an evidence-based tool-kit and guidelines. Nursing care happens to be a very important factor within health care and results in a great influence upon the patients, having an effect upon their emotions, wellbeing and health. Still, there is always a likelihood of there being bad nursing practice at one time or the other. There is also a likelihood of unprofessionalism on the part of the nurses to still be there and even be entrenched into practice. This will definitely threaten the patients’ wellbeing since they would be exposed to neglect and undeserving care. Such a practice might even implicate other medical professionals within the process until and unless someone stands up and challenges it. References Read More