I am new to school nursing (worked L&D for 18+ years) and find it to be a challenge. I have a student (actually a few students) that exhibit self-harm in the form of cutting. It seems to me that this is "the new black". I had a pediatrician call me and ask if I had reported an incident to CYFD. This seems a little extreme to me. 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!
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.
God bless you school nurses. A school nurse pal said she had to go up on a roof where a kid got hurt (don't ask, sigh) and a pregnant girl went into labor! Amidst more routine but basically non-stop days when she didn't get lunch even.
I don't even know how to articulate my feelings about self-mutilating. I began cutting, carving and burning and piercing myself when I was around 11. I still have scarring to remind me of how much harm did to myself. I asked for help at the guidance office and nothing came of it - essentially no one took me seriously when I tried to explain how much I just couldn't deal with my life circumstances. I was popular, got great grades,but I had no emotional support at home. My father left us and my mother had a nervous break, we stole food from the grocery store to eat. I was raising my little sister and eventually turned to street drugs to cope. I had a teacher in 7th grade who saw markings around my elbow where I had carved an inverted cross and took me out of the class and began crying - she was the first adult who I felt cared about me. I still struggle and I grew older I put myself in increasingly risky situations. I hope you take these children seriously, they need someone to help them.
Specializes in Med-Surg, Geriatric, Behavioral Health.
Good job. "Safety First" often becomes our top principle that directs everything that we do. Is the patient safe? In regard to self injurious behavior, the need for setting limits on behavior directly/indirectly and for implementing interventions to reduce such risks are certainly within our realm. Oftentimes, this may be simply being that we step in as a patient liaison that pulls in other resources for that patient. In this case, parents, psych, social worker, the E.D. Never take something like this upon yourself alone as a nurse. When it comes to unsafe behavior, we need to take this seriously, assessed and intervened. Regardless of the reason why a person cuts, it is not your issue. Your issue is to answer that question...Is the patient safe? If the answer is no, then assess and intervene upon the immediate risk at hand and then liaison out for the patient as their advocate. Good job. Good job.
Kooky Korky, BSN, RN
5,216 Posts
God bless you school nurses. A school nurse pal said she had to go up on a roof where a kid got hurt (don't ask, sigh) and a pregnant girl went into labor! Amidst more routine but basically non-stop days when she didn't get lunch even.