When patients self-harm, who tends to it?

[LilaDavis]

Hi everyone!

I'm not currently a nurse (thinking of it) but I work on an inpatient acute ward on the psychology team. Over the past year or so we've had a major increase in patients with PD diagnosis and self-harming behaviors.

I'm curious because the nurses I work with seem to have different attitudes regarding the issue of self-harm. Once they've been notified of/observed a patient self-harming, they will assess the wounds. Assuming they don't need emergency treatment, the approaches are very different. Some nurses will flat out refuse to clean/dress the wounds (unless it's more serious) and will instruct the patient to do so, sometimes under observation. This also includes cleaning their bed area or wherever they have self harmed, if there is blood etc.

Their rationale is that for chronic self-harmers, the aftercare is reinforcing the behavior because they crave that kind of attention/affection. They're not rude or nasty about it, but firmly tell the patient it's their responsibility.

Other nurses will just immediately clean it up and treat. So I'm curious, what happens on your ward? What are your own thoughts?

[audreysmagic, RN]

It is pretty amazing. I feel like it's futile sometimes to just keep banning materials because one person is clever enough to make a self harm tool. One hospital I worked at required us to remove under wires from bras, and another had to remove all the springs from the soap dispensers. A third patient who was on a 1:1 somehow got a hold of a rubber band/hair tie and kept smacking her skin with it, which drove staff nuts. Adolescents are the most clever in my experience.

We've had to remove the bathroom soap dispensers on my adolescent girls' unit due to them figuring out how to get them open and removing the springs. We had to get rid of pencils, markers...now we're down to crayons...WHICH HAVE ALSO BEEN USED INAPPROPRIATELY, but we haven't banned them because what ELSE is there for the kids to write with? I've always said that I want a recovered self-harmer doing my contraband checks, because they'd catch anything...

To answer the original question, I wouldn't ever have them dress their own wounds. Assess the wounds, dress them, and do a little forensic work to find out what they used if you don't know, and treat it non-judgmentally - which can be hard with some patients, admittedly. If this patient is one who tends to use it as a form of attention-seeking, then I do tend to make minimal conversation and keep my questions purely medical. If they do it on my unit, they'll be put on 1:1. The ones who are distressed, I'm a little more therapeutic with in the moment. As other posters have said, it's really an individualized thing.

As for how they self-harm on a unit, some of them are very familiar with the system and know that we have q15 checks on everyone. I've had many patients watch and wait for the tech with the q15 duties to go by, knowing they've got 15 minutes to do what they're gonna do.

Non-self harm related...if a patient makes a mess that's purely intentional, I WILL make them clean that up themselves...or at least try.

[audreysmagic, RN]

never give a sanitizing wipe to a Patient.

I'd have retired by now if I had a dollar for every time I had to remind people of this...granted, at least it was never related to bodily fluids.

[James W.]

This aspect needs to be specifically addressed in

the patient management plan, & Ok'd by the treating team.

If a certain level of (essentially superficial) self-harm 'scratch' is

deemed Ok, as agreed by the patient & the T.T., no big deal.. it

can be a trust/autonomy exercise that reduces angst for all..

Of course, however, seriously injurious self-harm & intense acting-out

behaviour that is predicated to distress others, is quite another matter..

..the consequences for which - also ought to be noted in the P.M.P...