What Nurses Need to Know About Cutting

Chronic consitions anf acute care crises are not the only area in which nurses serve their patients. Nurses must be vigilant to observe compulsive and dissociative disorders beginning among their patients in care. When a patient is at risk for harming themselves, the situation becomes a health care crisis.

Patients under monitoring will exhibit patterns of normal behavior. Then changes in a patient’s habits will stand out.  One aberrant behavior that signals the need for attention is cutting. Cutting may sound odd, even absurd to most people when first encountering the medical disorder. But cutting is no laughing matter. It can affect housewives, adolescents, students, and profession people of all ethnicities  and at every education level.

Yet the  problem of cutting is more widespread than thought at first, although experts cite early underreporting as a major factor. Many caregivers may not wish to risk their position on an intervention. Irregular nursing staffing can result in turnover that prevents consisted reliability between caregivers with an opportunity to see cutting symptoms.

Cutting is a problem that has become a recognized part of the vocabulary of disorders and psychological signs of emotional distress in people. Striking mainly juveniles and adolescents, cutting is a practice where the physical mutilation of the skin serves no purpose but abuse. Cutting flourishes in environments where body checks and inconsistent observation is the norm.

Both women and men suffer from cutting. The inclination will start small, and the disorder will build as the victim of cutting behavior learns to harm themselves routinely. Cutting may be hidden by hobbies such as carpentry, fishing, sports, and crafts where cuts and abrasions can be shrugged off as casual. Where cold weather can conceal skin condition, nurses should urge patients to change into a gown for evaluation. Many doctors who skip the full-body evaluation can miss the signs and symptoms of cutting right under their nose.

Cutters are trying to treat their emotional pain. The individual will start to experiment and transfer feelings of emotional pain to a physically concrete manifestation of cuts, bruises, lesions, in areas not regularly seen by others. This is regularly in the lower arms and forearms, which can be hidden by long sleeved clothing. The individual will withdraw from normal social activity if it reveals their cutting scars or lesions.

Therapy for cutting involves multiple disciplines. Treatment involves  confronting the cutter in a safe space and  from their caregivong usually takes the form of two tiers of treatment. Skin cuts are treated for infection and bandaged, and mild painkiller is prescribed. Psychiatric examination and counseling make up the other part of treating cutters.

It would seem that those in metaphorical pain would avoid seeking actual pain. Yet for many this is bringing their pain into the open. Wound care nurses should be wary of patients who pick at scabs or worsen wounds and lesions between dressings.   Yet the exhilaration and catharsis of the cutting ritual allows the individual to achieve emotional release from psychological pressure. Cutters can form bonds with website friends online part of the cutting world.

Cutting is usually done by persons who feel helpless to control important aspects of their lives. Cutting is generally a shameful secret they hide. Cutters should not be condemned, but take in recommending the case for treatment. Friends should report this to a doctor or physician for further investigation.

Signs and symptoms of self-injury may include dermal scars that can be seen in those who have been practicing the self-abuse of cutting for some time. Referrals to the appropriate speciaist are encouraged.

Cutters may distinguish themselves by having sharp objects like pins, knives, switchblades, or razors on hand. They may be seen to wear long sleeves on their arms  and long pants unseasonably in hot weather. Cutters often exhibit difficulties in having close friends near, or holding long-term friendships or have difficulties in interpersonal relationships. The intimacy and familiarity required in these relationships make it difficult for the cutter to hide the cutting habit.

The habit of cutting may become a compulsion for some , one they wish to hide. Conditions in the cutter’s life may lead them to question their existence and voice thoughts of hopelessness or confusion. Stressful life events such as loss of a loved one, decline in social contacts,and new changes in negative life experience may signal a potential for cutting.

The patient or individual will mull over questions about his or her personal identity, such as “Who am I?”, “Where am I going?,  “What am I doing here?” They may exhibit panic and confusion when confronted with obstacles.  Nurses should be alerted to patients with pronounced skin conditions and the above mentioned problems.

Patients involved in cutting behaviors will experience behavioral and emotional instability, such as uncontrolled crying or mood extremes.  Cuters may ecperience problems with impulse control, and be subject to violence aggressiveness or other taboo behaviors. Cutters form a new routine, replacing the chaotic unpredictability of their problems with the “control” of the cutting instigation.

There may be a detectable change in patients, from an external viewpoint. . A patient who usually goes out for a walk or shops with friends and suddenly elects to stay in or avoid phone calls may be a patient considering cutting or performing the cutting practice as a way of coping. The cutter’s disorder is marked acute when the individual finds solace or relief in cutting.

Nurses should discuss with the charge nurse, roommate, staff nurses and social if they have overheard the patient make statements of helplessness, hopelessness or worthlessness. Futility and despair are the emotional hallmarks of a cutter. Intervention is only possible if the caregiver or nurse steps in and speak up.

Where Have All the Good Nurses Gone?

Those familiar with the nursing landscape and the patient options universe have been noticing a talent vacuum for some time. Has the general quality of nursing fallen off? Where have all the good nurses gone? Hospital policy and budget cuts, public mental health policy and supervisory practices combine to eradicate the best and most talented nurses out the door.

Risk averse nursing workplaces are becoming harder and harder to find, thanks to Social Security’s failure to keep mentally ill populations locked appropriately in pace. Mentally ill patients now take up regular population beds, a violation of nursing care in ethics if not in deed. Because these are not actually critical care patients, i. e. no amount of direct nursing care can restore mental logic or activities. Many new nurses (and old ones) do not have concentrations and/or documentation and licensing for strictly psychiatric patients, even if patient organization loads and assignments offer them these patients!

Consider: if a nurse applied for a position of equivalent nursing station in a psychiatric ward they would not be accepted because they did not have the credentials or experience. These patients would formerly have been residents of hospital wards more suited to round the clock care specific to this kind of patient need. And ward backups could otherwise have absorbed the extra patient care load.

But burnout of regular nursing staff and nursing shortages are behind this new gap in patient care. Why, as one old pro asks, should they wear themselves out simply because the State wants to save a few bucks on medical costs? They don’t get paid more for severely heavier care demand patients. But according to the present model of overstuffed wards, they are expected to do the work!

This “Lost Generation” of nurses will pass on thankless extra work, thank you very much. Generally speaking, more experienced nurses in older conventional labor models could be counted on to fulfill more complex nursing tasks to more demanding and more complex critical care patients, such as dementia, Alzheimer’s, or even Huntington’s Disease cases. But many experienced nurses looking to retirement do not feel the same push to fulfill additional case work per patient for no additional compensation.

More experienced nurses are simply not to be depended upon anymore to “pick up the slack” because newer grads want the easier cases and managerial staff can’t be troubled to properly supervise them. The charge nurses assign them to heavier load patients. Nurses are likely to pass on extra shifts or extra duty and extended hours, because they will simply get dealt the harder tasking. Nurses are likely to call in sick and take the personal time owing than spend the day chasing a thankless care load.

Many new nurses are “new grads”, shining with brand new diplomas but heartily lacking on practical nursing experience. New grads, as they are being termed are simply not experienced enough to care for mentally ill patients. These patients can be a significant drain on ward care time, because they need nurturing and coaxing to eat, take medications, and need more intensive body nursing than an ambulatory patient. And ambulatory and non-mental patient populations are deleteriously affected. Patients who “behave see the “problem children” get all the attention.

How taxing is the average mentally ill patient on a regular care ward tasking? Take for example the fictional case of “Robert Fickle,” an aging dementia victim undergoing unilateral amputation of the right leg. His care requires negative ionization chamber care and round the clock nursing care of a (1:1) one to one ratio assigned directly to him. But there is no rest for those on the same ward as Robert Fickle.

Fickle has transformed a quiet and orderly ward into a chaotic and noisome irritant. Bawling incessantly, he wears down every nurse and supervisor. Encouraged by the attention he receives, Robert continues to yell and scream if he does not get the attention of every person who passes into his field of vision, and yells abuse at other patients or staff if they do not instantly hurry to his side. The social worker licensed to carry out medical activities for Robert Fickle is only employed onsite from nine a.m. to five p.m.

Robert has abandoned all attempts at coping and spends all night yelling at nurses and passersby in the ward. Robert refuse to wear his hearing aid and can be heard all the way down the hall on a nightly basis, haranguing nurses for hours about fictional missed appointments he must get to (at five o’clock in the morning). There is no way to shut the noise out and other patients suffer to no avail.

Robert’s constant verbalizations wear out the nurses, who must complete the charts and medicine dosages of other patients while this noise is going on. It is very distracting and nurses feel put upon to keep their performance error free in this environment. The new admissions to the ward are accompanied by family and visitors, who are struck with amazement at this spectacle while their loved ones are taken into “restful” hospital care.

Sickle’s “condition” rule the ward. He refuses to stay in bed and insists on sitting in the doorway of his room, heckling patients and hospital staff, employees and visitors alike as they walk by, with imperious screams and abusive catcalls. Hospital policy limits what nurses can do or say to limit this nuisance. Numerous complaints from other patients go on “deaf ears”.

So, where are all the good nurses? Looking for alternate employment, or counting their days until retirement. And considering that any of us might be the next “Robert Sickle”, that is food for thought indeed.