Cutting

Dogen · Feb 12, 2016

While it is not a suicidal gesture, and self mutilation instead, the problem is that these children are more prone to suicide not at that time but later on because they have lost the fear of hurting themselves. This is a problem where the entire family needs help because the child is exhibiting their emotions and trying to deal without having coping skills.

This is an important topic in any discussion of self-harm or suicidality. Thomas Joiner's interpersonal-psychological theory of suicide posits three essential ingredients: perceived burdensomeness, social isolation, and an acquired capability. Acquired capability includes a history of painful or provocative experiences that develop a tolerance to physical and emotional pain. This may be the crucial difference between suicidal ideation and a suicide attempt.

Which is all just to say that I'm glad it was mentioned, because while a self-harming child may not intend to die today, they might at some other time, and so getting treatment before they've become habituated to physical pain may save their life years after you intervene.

%D#2 · Feb 12, 2016

With cutting and other parasuicidal behaviors, you shouldn't draw attention to it. As stupid as cutting is, most of the time it's just scratching. If they're depressed, medicate appropriately and send to therapy. RTFs and TDTs are hot boxes of misbehavior so not the best option.
Adults I have no empathy for. I have a patient who cut apart his forehead with a box cutter. My response beyond asking his motivations was "that's definitely gonna leave a scar." I have another adult who cuts and recently too deeply. Real deep. Sliced brachial artery and spurted out until her 15 year old daughter applied direct pressure and literally saved her life. She has PTSD now. I treated her and berated the mother who gets psych care from an under informed IM guy.
Kids cutting is exhausting as are the kids who come in with parents wanting them diagnosed with and treated for mental illness after texting nudie pics around the school. They're both bad and bizarre. Both are detrimental.

I'm not trying to split hairs here but your perception of this is rather skewed. Sending a nudie pic and cutting are so different. I have an adult friend who cut. She was in fact suicidal but was cutting to get by while formulating a plan which I later found out.

She hadn't picked up her phone in days.. I went to her house and one of her cuts was so deep it required stitches and got infected. She was so hesitant to go to the hospital because she was afraid of nurses being apathetic or judging her. She was so afraid I had to call 911 while she went into full blown panic attack. Was it exhausting for me? Yea! And it was exhausting for months and months after that, while she was in recovery. I worried day and night. But she got the help she needed and not just medical help.

Physically treating it is only scratching the surface.. Only getting them better physically so they can go back to self harming. She went inpatient for a few weeks.. Got lots of insight and protection while vulnerable, and continued outpatient counseling and still does to this day.

My point is, no matter how old someone is they still deserve proper treatment and empathy. They are still human and have issues that need to be addressed.

And my other point is to anyone who thinks cutting is just a trend please don't make that generalization. It's a cry for help and often a valid one. No matter what you're opinions are you always have to act on it like its a critical and serious matter.

RNdynamic · Feb 12, 2016

What is the new black? Just curious what the expression means.

kidzcare · Feb 12, 2016

What is the new black? Just curious what the expression means.

Saying something "is the new black" is a way of saying it's the latest fad or fashion- something all the "cool kids" are doing

NanaPoo · Feb 12, 2016

These behaviors are often a release mechanism and the student is enrolled in therapy to learn healthy coping mechanisms. How do you handle these situations? The student is 16 and lives with her adoptive father.
I work in a rural school setting...pre-k-12...380 students. I see 40-60 kids a day!
Thanks for any advise...

I know I'm late to the thread but I appreciate you bringing this up, ruralSchoolRN! This has been high on my list of things to address at my school and with my principal and faculty. I am pretty new to school nursing as well. I've been here 2 years after 12 years of med/surg & hospice.

I'm going to stray off topic for one second then come back because there is some incredible stuff here. I'm being picky but why do you use the wording, she "lives with her adoptive father?" As an adoptive parent, I don't walk around saying, "Oh, hello. Have you met my adopted daughter?" Just like you wouldn't walk around with your biological child and say, "Hello, have you met my born daughter?" My daughter is just my daughter the same way anyone else's child is their child. Do you think her cutting has something to do with her adoption? Perhaps it does. The cutters I currently know here at school live with their bio parents. We have lots of adoptive situations here in my school and they are currently very stable and happy...no emotional or mental issues so far. Not that it's impossible, I know.

Sorry, I'll step off my PAL (positive adoption language) soapbox now. That's for another thread.

ANYWAY, thank you so much peeps for sharing your stories. These are amazing and you all are amazing for sharing what you've been through! I'll admit I have a favorite student that happened to have some self-injury issues last year. I keep her close and she's one I worry & think about. I've found evidence of another this year and have come to the realization that, even in my small school, this is a much bigger issue that I ever realized.

This leads to the questions I've wanted to address here:

Do your schools have self-injury policies or procedures? For example, when you or another staff/faculty find(s) evidence that a student may be self-injuring, do you have a protocol that you follow as far as who is notified or what you do next? I had a front office staff tell me she "may know of someone who's cutting" and I thought, "ok, where do I go from here? What are the rules on this??"

Farawyn · Feb 12, 2016

What is the new black? Just curious what the expression means.

"Well oiled hair" is NOT the "new black".

Farawyn · Feb 12, 2016

NanaPoo, I usually evaluate the injuries themselves, then I call Psych. Depending on my relationship with the student, I mostly stay involved in the process, initially. Psych will speak to the student in my office. Psych will escalate and call the parents as needed.

I document thoroughly.

The cutting usually opens up a bigger can of worms, re: stuff going on at home, or at school, etc. so Psych is always involved.

JenTheSchoolRN, BSN, RN · Feb 12, 2016

NanaPoo, I usually evaluate the injuries themselves, then I call Psych. Depending on my relationship with the student, I mostly stay involved in the process, initially. Psych will speak to the student in my office. Psych will escalate and call the parents as needed.
I document thoroughly.
The cutting usually opens up a bigger can of worms, re: stuff going on at home, or at school, etc. so Psych is always involved.

Similar to Far, I take clear of the physical wounds (and document them and my care of them) and call our counselor and school psychologist for help with a further eval.

It does involve calling the parents, of course, but is a team effort. I do typically stay involved during the early process as every student that has come to / been brought to me to evaluate wounds has been a student I've had a good relationship with. I manage about ~500 kids, so I get to know many of them.

poppycat, ADN, BSN · Feb 12, 2016

Farawyn is absolutely right that the cutting usually opens up a bigger can of worms. I know with myself there was a lot of stuff inside that I had no one (at that time) that I could confide in without being judged. Incidentally, I didn't start cutting until I was 28 after an extremely abusive marriage. It doesn't always start in childhood or adolescence.

NanaPoo · Feb 12, 2016

So, you have your own personal policy but no official written school policy?

I've seen some schools locally and nationally actually have an official policy and procedure to follow when a student is discovered to be self-injuring.

NutmeggeRN, BSN · Feb 12, 2016

Farawyn is absolutely right that the cutting usually opens up a bigger can of worms. I know with myself there was a lot of stuff inside that I had no one (at that time) that I could confide in without being judged. Incidentally, I didn't start cutting until I was 28 after an extremely abusive marriage. It doesn't always start in childhood or adolescence.

Not "like" liking, just showing support of what you are saying, Glad you are in a better place!

Kooky Korky, BSN, RN · Feb 13, 2016

There are no words...

Sure there are.