We are assigned a scenario in mental health for which we need to create a care plan. Mine is a young woman living in a group home who won't contract for safety and has a history of self-injurious behavior. She promises that if she is returned to the group home she will cut herself.

We are to establish ONE primary nursing diagnosis, one outcome, two interventions.

This is what I came up with. Thoughts? I had a difficult time deciding on an appropriate timeframe.

We cannot use "Ineffective Coping", by the way.

Self-Injury Care Plan

Scenario

Jillian is a 25 year old mentally disabled woman who lives in a group home with supervision 24 hours each day. In spite of this she manages to find ways to harm herself. Last night she removed the light bulb from a table lamp, broke it and used the broken glass to cut her wrist. She has cut herself for many years, stating that it helps her to feel better. The staff from the group home bring her to the Emergency department for admission to the hospital as she refuses to contract for safety. Multiple strategies for keeping her safe are discussed but she stands firm that she will find a way to hurt herself if she returns to the group home. She is admitted to inpatient.

Nursing Diagnosis

Risk for Self-Mutilation related to history of self-injurious behavior and living in a nontraditional setting (group home) as manifested by patient states she will find a way to hurt herself if she returns to the group home.

Outcome

Patient will refrain from self-injury as evidenced by no attempted or successful episodes of harming herself by end of shift.

Interventions

Intervention #1: Nurse will remove all breakable, sharp, flammable, and pointed objects from the patient's environment.

Rationale: This patient is in crisis and, since she will not at this time contract for safety, is at high risk for imminent self-injurious behavior. Removing the objects typically associated with 'cutting' behavior from the patient's environment will help mitigate the risk she will attempt or succeed in injuring herself.

Intervention #2: Nurse will monitor patient at frequent but irregular intervals to help ensure ongoing patient safety.

Rationale: Ultimately the nurse will need to help the patient identify triggers to self-mutilation and maintain self-control without supervision. In this crisis period, however, the patient will require frequent monitoring as patient safety is priority in Maslow's hierarchy of needs. (Townsend, 2012) In addition, monitoring should be done at irregular intervals to prevent the patient from noticing a pattern and plan for self-injurious behavior when she expects the nurse will not be there to interfere. (Ackley & Ladwig, 2011)

Good job. Time frame is "while in unit." You can't do anything when she is out of your care.

I agree with Grntea

Thank you both!

I am finding mental health challenging in terms of the thought process.

This is why those of us who deal mostly in physiology think psych nurses are all crazy. Challenging thought processes, indeed.

:: ducking and running ::

(Really, one of my best friends is a psych nurse!)