Week 1 Discussion

DQ1 You are working with a nursing student who is introducing herself to a Native American patient to establish rapport. The nursing student is trying to make eye contact and puts her hand on the shoulder of the patient to get his attention. What situation could arise with this approach?  How would you handle this situation? Defend rationale with references.

DQ2 While completing a health assessment, you notice that there are indications that the patient may have been cutting herself. You inquire about the marks and she indicates that she scratched her wrist when she tried to break her fall. How do you handle this information? How can you incorporate your Christian worldview to help in providing quality care? What are the key elements to accurately obtaining the needed information for effective treatment?

Why would someone deliberately hurt herself? The notion might seem odd—but as a nurse, you may encounter patients with signs of selfinjury (also called cutting, selfinflicted violence, self-harm, or self-mutilation). Cutting the skin is the most common form of self-injury. Other forms include self-burning or branding, pulling out the hair (trichotillomania), and embedding items under the skin—for example, sewing needles or paper clips. Over time, individuals may harm themselves repetitively; some report they’re addicted to this behavior.

Although self-injury by itself doesn’t indicate suicide risk, it can lead to serious health consequences. Cutting too deeply or getting an infection at the injury site may lead to septic shock or, in rare cases, death. Self-injury also has detrimental effects on mental and emotional wellbeing and leads to feelings of guilt, self-loathing, and shame.

When encountering patients who seek treatment for self-inflicted wounds, some healthcare professionals may become frustrated, especially if they’re not adequately educated about this behavior. To make a significant difference in these patients’ lives and provide ethical and equitable care, you need to understand their behavior, be able to identify warning signs, and promote effective treatment.

Cutting ritual

For many who harm themselves, the act is a ritualistic event performed in a premeditated way in a controlled environment. Some devote considerable time to finding the right utensil and go to great lengths to carry out the injury.

Many self-injurers try to hide the injury out of guilt or embarrassment. They may wear long sleeves in the summer and make excuses for telltale marks, claiming they’re from animal scratches. But others are forthcoming about the real cause, even showcasing intricate carvings—especially when admitted to a mental health facility.

Who does it

Self-injury is most common in adolescent females but can occur in adults. Some studies suggest females are more likely to harm themselves, but other research has found no gender differences.

With an incidence of just 1%, self-injury isn’t common. Accurate estimates of its incidence and prevalence are challenging because most people who injure themselves conceal their behavior.

Body areas most often abused are the legs, arms, and front of the torso. These areas typically are covered by clothing, so if you suspect self-injury, be sure to examine them and intervene early to help eliminate this unhealthy coping method.

Why they do it

Always a cry for help, self-injury typically arises secondary to a core problem and is linked to a stressful situation. The person can’t cope with deep psychological pain in a healthy way and self-injures to relieve pain or eradicate emotional numbness. Self-injury causes immediate release of endorphins, which can help the person escape temporarily from emotional pain. Although short-lived, this endorphin-induced euphoria can easily lead to addiction.

Reasons for self-injury can be complex and in many cases stem from trauma or psychological disorders. The behavior is common in victims of sexual abuse and in persons with eating disorders, borderline personality disorder, cognitive impairment disorders, obsessivecompulsive disorder, and dissociative identity disorder. People with psychosis may hear voices commanding them to hurt themselves.

Many people who harm themselves chronically have posttraumatic stress disorder (PTSD) resulting from emotional, sexual, or physical abuse or neglect as a child or an adolescent. In some cases, this behavior is an attempt to keep a loved one concerned and connected (most common in those with borderline personality). In others, it represents an attempt to relieve stress, as from financial or marital problems or parenting issues. Self-injury occurs in an estimated 25% to 40% of persons who already have mental health issues.