Psychiatric Nursing And Self-Injurious Behavior

In the forensic psychiatric setting, patients who express feelings of suicide are put on a one to one staff to patient observation, also known as suicide watch. It is my opinion that patients who exhibit “self injurious” behavior should not be placed on this same continuous one to one staff to patient observation. A distinction between suicidal behavior and self-injurious behavior must be made. Self-injurious behavior can be defined as deliberate, direct injury to one self that causes tissue damage (www.selfinjury.org). Unlike suicide, it is not an attempt to cause death. Self-injurious behavior includes acts such as cutting, pinching, burning, scalding, scratching, inserting objects into body cavities, and breaking one’s own bones etc. It is usually an attempt to deal with an emotionally overwhelming or distressing situation that the patient cannot deal with in any other manner. Other reasons given by patients for self-injurious behavior are: distraction from emotional pain, calming intense feelings, self-punishment, expression of feelings that they can’t put into words (www.selfinjury.org). Common myths about self-injurious behavior are: it is a failed suicide attempt, it is a psychotic act, it’s an attempt to get attention, and it’s an attempt to manipulate (www.selfinjury.org). The self-injurious behavior serves a function for each patient. A patient that I worked with for several years stated that his anxiety from his childhood sexual molestation would build and build for days or weeks. The only way he could alleviate the anxiety was by cutting. He tried not to cut but could find no other way to stop the guilt, anxiety, and emotional pain. The function that the cutting served was as a coping mechanism. If he had placed on suicide watch, he would have been unable to cut and would have not been able to deal with his anxiety. The literature states that individuals have actually attempted suicide when they were unable to perform their self-injurious behavior. It is up to the psychiatric nurse and the interdisciplinary team members to figure out what function the self-injurious behavior serves for the patient and help him learn alternate ways and skills to get those needs met.

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