Self harmers

Hi, been a few years since I posted but would like some input please.

How do you manage pt's that self harm in an inpatient environment?

At present we have a very hands on approach which usually results with intensive nursing in a highcare environment. This is not ideal as it removes a number of nurses from the main ward. Sometimes up to 3 nurses with the patient to stop them.

Any input would be great.

Short of a staff member holding each hand, you cannot keep this person safe.

Wouldn't shackles be indicated for such high risk?

We really try not to use it, but we have a restraint chair which is essentially a wheelchair with restraint straps. We have a de-escalation team we page and they come down (maybe, if their units aren't acute) and help try to talk the pt down or help place them in the chair.

We used to do the butterfly project. Also, we taught them to draw instead of cut. A lot of facilities don't like the patients to write on themselves though. To me washable marker seems a lot less of an issue than cutting but I don't make the rules.

Also, encouraging a lot of dialog so that they feel safe telling you when they want to cut without getting in trouble. Then, you can talk with them and help them find acceptable coping skills.

Another thing I found helpful was to keep them busy. If they started to get restless I'd have a mini group, we'd decorate the walls, play games together, do dance workout videos, I'd post journal prompts. I worked on an acute all girl self harm unit for 3 years. It can be exhausting keeping them safe, but I left there 2 years ago and I still get random thank you Facebook messages. (We're not Friends they just message)