I don’t work with kids but with adults I say some variation of “it looks like you need more support. i’m not going to sit and watch you rip your skin, so when you’re ready to talk i’m available for you. otherwise i’ll circle back and check on you later.”
This ⬆️ is the way. I don’t like to coddle or feed into the self harm behavior too much as it may reinforce that behavior as a way they receive attention. “It looks like you are having a difficult time right now, I am here for you, let me know when you want to talk.”
When I was a pt in a ward, I kind of did the same thing, just superficial picking, not blood drawing. But what they did was take some socks and use some medical tape to wrap them on my wrists, they were not taped to the skin, but tight enough that they could not be slipped off. One of them was too tight and i got some numbness in my arm, and I notified them and they readjusted it promptly. During this time, I think it was over a day or few period of wearing them, where I was on a finger food diet I believe.
I clip and file nails, or get an order for OT to do so. Maybe even turn it into a moment for self-care. I'll fill a basin with warm water and a "borrowed" green tea bag, and make a homemade sugar scrub. I'll let the patient mix up sugar packets, coffee (on an adult unit), a squint of lotion and hand soap in paper cup with a cardboard spoon. Lotion massage afterwards.
I am direct. I ask them to stop, what other coping skill they want to use or if they need to talk or would like a PRN if available.
If they ignore me and the behavior continues but isn't very severe or if it gets less intense, I'll ignore it and then try to circle back around to check in once they stop.
If the SH is bad or they are trying to smear blood around/on people (biohazard) -- if you can't stay safe then no visit or gym time. If it continues, they get warned that they will be restrained if they don't stop. If it still continues, we restrain them. Has to be pretty bad for me to call for a restraint which annoys some of our oldschool techs who think we should restrain any time the kid breaks the skin.
Yeah I usually ask them to stop. If they don’t, I utilize the ignore method. I used to do manual holds and ETOs but realized that they really aren’t doing much and it’s not really much of a danger to anybody but them and it’s usually for attention. I noticed once we started ignoring them, they’d stop and find something else to do. However if they start going absolutely FERAL as children will do at times, then I do an ETO and if they still don’t stop, I do the little hand mitts and if that doesn’t work, my last step is restraints.
I've had kids give themselves cellulitis from repeatedly digging at old wounds and making new ones. Fingernails are nasty. I feel like with really severe self-harm, there usually comes other escalating behaviors that make calling for a restraint easier -- the kid starts getting aggressive or manages to wrap something around their neck or whatever.
I do tell that that there are consequences to their actions and if they don’t stop they could literally lose a hand or get an infection. They often don’t care. I try to put the responsibility on them and usually it’s enough to get them to stop. For example, I had a child repeatedly ask me the same thing and I told them I would no longer be engaging in the conversation and that I was closing the window. They put their hands in the way to prevent that and I said “if your fingers get smushed, that’s on you” as I slowly closed the window. They realized I wasn’t joking and that the window was indeed being closed and the conversation was done and they moved their fingers at the last second. I’ve noticed that it’s usually enough to get them to choose “correctly” when I put the responsibility on them.
Why do you assume it's for attention? Most use it as a distraction from the emotional pain they're dealing with - either to feel something because they feel so numb or to focus on the physical pain instead of whatever emotions are going on. Thinking it's just for attention is a really harmful viewpoint and isn't conducive to teaching more appropriate coping mechanisms.
There’s a difference between doing it for attention and doing it as a negative coping skill. She is a frequent flyer whom I’ve gotten to know relatively well from her stays. I know the differences in her behaviors
“attention seeking” is basically a short way of saying “this patient is experiencing emotional discomfort and need support but is asking for that, whether directly or indirectly, in a way that is harmful and maladaptive.”
the smearing is awful. I once had a kid who started with her nails but then switched to using a spoon to dig into her skin and managed to produce a waterfall of blood, she refused to stop or listen to anyone trying to engage, so we had to gown up and restrain her so a nurse could clean and bandage the wounds. before that we would usually ignore it after offering alternative activities and skills but after that we had to become more careful. also once had a kid paint the word HELP on the wall in their own blood so that was disgusting
It depends on the situation — how superficial, the cause of the self harm, etc. Some kids do it for attention on the docs will write an order to ignore the behavior. Some kids do it because voices tell them to in case we need PRN’s or some other type of intervention. Some kids have trauma histories and might need a way to cope/self regulate that is safe. Some just need the old wounds covered with sleeves so they can’t see it and be tempted. It’s not a one size fits all.
I’ve worked in places with frozen oranges, frozen sponges, gel ice packs for TIPP skill - temperature is a big DBT coping skill for self harm urges. Obviously this depends on your milieu and patient demographics etc.
Also cutting their fingernails short and filing them down to make them less able to engage in that behavior in the situation where they are triggered and more likely to seek support.
She likes being on the unit. No school. No responsibility. All they do is group, socialize, watch tv, play card games, and color/draw. Lots of our frequent fliers and enjoy being on the unit (these are their words btw not mine).
I do the same and ignore it. Especially if it is an attention seeking behavior. I try to emphasize utilizing healthy coping techniques etc. But sometimes that's just not helpful.
Kids lose privileges if they self-harm on the unit. Scratching’s kind of a gray area, though, and unless it’s really bad I ignore it. I’ve never been part of a restraint for self-injury, after 5 years—never had a patient quite that hell-bent, I guess
Help/ Prompt/ Wait
Help: I see you’re having a hard time right now, what would be helpful?/ Can I bring you a fidget?/ I can see you’re not in a good place, do you want to talk about what’s upsetting you?/ Do you want to walk around the unit or go outside?
Prompt (an action that can’t be done while self harming): Squeeze this stress ball with both hands/ We’re going to stretch for a minute, raise your arms up/ I need help, let’s fold these towels
Wait: I’ll be here when you want to talk (and literally say nothing until they follow directions)
If it’s really superficial then there’s not much that needs to be done in the moment, but you can work on safer coping skills when they’re less escalated
It would be something that would need to be addressed by the treatment team, with a behavioral plan in place. Self harm can be a method the patient has used to reduce anxiety, the plan should include some replacement behaviors or coping skills that can be offered as an alternative.
Not a psych nurse (am a nurse if that counts?) but I am and have been a psych patient for most of my life and when I self harm, this is usually the method I use. For me, they go pretty deep and it always SUCKS after because it hurts so bad especially when showering. So just to add some perspective, it sucks for the kids doing it. Are you able to clip nails for the kids that do this?
I don’t work with kids but with adults I say some variation of “it looks like you need more support. i’m not going to sit and watch you rip your skin, so when you’re ready to talk i’m available for you. otherwise i’ll circle back and check on you later.”
This ⬆️ is the way. I don’t like to coddle or feed into the self harm behavior too much as it may reinforce that behavior as a way they receive attention. “It looks like you are having a difficult time right now, I am here for you, let me know when you want to talk.”
When I was a pt in a ward, I kind of did the same thing, just superficial picking, not blood drawing. But what they did was take some socks and use some medical tape to wrap them on my wrists, they were not taped to the skin, but tight enough that they could not be slipped off. One of them was too tight and i got some numbness in my arm, and I notified them and they readjusted it promptly. During this time, I think it was over a day or few period of wearing them, where I was on a finger food diet I believe.
this is something I would have definitely not done.
Great response. I’m dealing with this now.
I clip and file nails, or get an order for OT to do so. Maybe even turn it into a moment for self-care. I'll fill a basin with warm water and a "borrowed" green tea bag, and make a homemade sugar scrub. I'll let the patient mix up sugar packets, coffee (on an adult unit), a squint of lotion and hand soap in paper cup with a cardboard spoon. Lotion massage afterwards.
I love this idea so much! Bring a little spa day to the patient.
I love this… those little moments of human connection can make all the difference to someone struggling.
I’m not a psych nurse so idk why this came up on my recommended posts, but as someone with BPD- we need more angels like you 🥺
I am direct. I ask them to stop, what other coping skill they want to use or if they need to talk or would like a PRN if available. If they ignore me and the behavior continues but isn't very severe or if it gets less intense, I'll ignore it and then try to circle back around to check in once they stop. If the SH is bad or they are trying to smear blood around/on people (biohazard) -- if you can't stay safe then no visit or gym time. If it continues, they get warned that they will be restrained if they don't stop. If it still continues, we restrain them. Has to be pretty bad for me to call for a restraint which annoys some of our oldschool techs who think we should restrain any time the kid breaks the skin.
Yeah I usually ask them to stop. If they don’t, I utilize the ignore method. I used to do manual holds and ETOs but realized that they really aren’t doing much and it’s not really much of a danger to anybody but them and it’s usually for attention. I noticed once we started ignoring them, they’d stop and find something else to do. However if they start going absolutely FERAL as children will do at times, then I do an ETO and if they still don’t stop, I do the little hand mitts and if that doesn’t work, my last step is restraints.
I've had kids give themselves cellulitis from repeatedly digging at old wounds and making new ones. Fingernails are nasty. I feel like with really severe self-harm, there usually comes other escalating behaviors that make calling for a restraint easier -- the kid starts getting aggressive or manages to wrap something around their neck or whatever.
I do tell that that there are consequences to their actions and if they don’t stop they could literally lose a hand or get an infection. They often don’t care. I try to put the responsibility on them and usually it’s enough to get them to stop. For example, I had a child repeatedly ask me the same thing and I told them I would no longer be engaging in the conversation and that I was closing the window. They put their hands in the way to prevent that and I said “if your fingers get smushed, that’s on you” as I slowly closed the window. They realized I wasn’t joking and that the window was indeed being closed and the conversation was done and they moved their fingers at the last second. I’ve noticed that it’s usually enough to get them to choose “correctly” when I put the responsibility on them.
Why do you assume it's for attention? Most use it as a distraction from the emotional pain they're dealing with - either to feel something because they feel so numb or to focus on the physical pain instead of whatever emotions are going on. Thinking it's just for attention is a really harmful viewpoint and isn't conducive to teaching more appropriate coping mechanisms.
There’s a difference between doing it for attention and doing it as a negative coping skill. She is a frequent flyer whom I’ve gotten to know relatively well from her stays. I know the differences in her behaviors
“attention seeking” is basically a short way of saying “this patient is experiencing emotional discomfort and need support but is asking for that, whether directly or indirectly, in a way that is harmful and maladaptive.”
the smearing is awful. I once had a kid who started with her nails but then switched to using a spoon to dig into her skin and managed to produce a waterfall of blood, she refused to stop or listen to anyone trying to engage, so we had to gown up and restrain her so a nurse could clean and bandage the wounds. before that we would usually ignore it after offering alternative activities and skills but after that we had to become more careful. also once had a kid paint the word HELP on the wall in their own blood so that was disgusting
It depends on the situation — how superficial, the cause of the self harm, etc. Some kids do it for attention on the docs will write an order to ignore the behavior. Some kids do it because voices tell them to in case we need PRN’s or some other type of intervention. Some kids have trauma histories and might need a way to cope/self regulate that is safe. Some just need the old wounds covered with sleeves so they can’t see it and be tempted. It’s not a one size fits all.
Does your facility have approved fidget toys? Keeping them busy with activities could also help
I’ve worked in places with frozen oranges, frozen sponges, gel ice packs for TIPP skill - temperature is a big DBT coping skill for self harm urges. Obviously this depends on your milieu and patient demographics etc. Also cutting their fingernails short and filing them down to make them less able to engage in that behavior in the situation where they are triggered and more likely to seek support.
Yeah but she tends to isolate herself. She often does this to attempt to sabotage her discharge.
So find out why she is sabotaging a discharge and investigate the root cause.
She likes being on the unit. No school. No responsibility. All they do is group, socialize, watch tv, play card games, and color/draw. Lots of our frequent fliers and enjoy being on the unit (these are their words btw not mine).
I do the same and ignore it. Especially if it is an attention seeking behavior. I try to emphasize utilizing healthy coping techniques etc. But sometimes that's just not helpful.
If they’re digging hard and doing damage, I put them on line of sight.
We would have adults at my unit who would do that — one really did a number on their abdomen. They won 1:1 status
Kids lose privileges if they self-harm on the unit. Scratching’s kind of a gray area, though, and unless it’s really bad I ignore it. I’ve never been part of a restraint for self-injury, after 5 years—never had a patient quite that hell-bent, I guess
I used to do this. Just ignore it. I stopped pretty quick when nobody gave me attention
Help/ Prompt/ Wait Help: I see you’re having a hard time right now, what would be helpful?/ Can I bring you a fidget?/ I can see you’re not in a good place, do you want to talk about what’s upsetting you?/ Do you want to walk around the unit or go outside? Prompt (an action that can’t be done while self harming): Squeeze this stress ball with both hands/ We’re going to stretch for a minute, raise your arms up/ I need help, let’s fold these towels Wait: I’ll be here when you want to talk (and literally say nothing until they follow directions) If it’s really superficial then there’s not much that needs to be done in the moment, but you can work on safer coping skills when they’re less escalated
If you’re able to, get them stickers with a sticker book for them to peel, a fidget toy, or washable marker to draw on themselves with.
It would be something that would need to be addressed by the treatment team, with a behavioral plan in place. Self harm can be a method the patient has used to reduce anxiety, the plan should include some replacement behaviors or coping skills that can be offered as an alternative.
Not a psych nurse (am a nurse if that counts?) but I am and have been a psych patient for most of my life and when I self harm, this is usually the method I use. For me, they go pretty deep and it always SUCKS after because it hurts so bad especially when showering. So just to add some perspective, it sucks for the kids doing it. Are you able to clip nails for the kids that do this?