[Body marking in psychosis]. / Les marquages du corps dans la psychose.

Patients with psychosis speak of an uneasy relationship with their body. Between feelings of too little and too much, for them it is a matter of trying to suture an image which is not always unified, a body which they are not always sure they have. The attentive clinician will attempt to support the solutions of each psychotic patient to maintain their body, beyond the death drive which pushes them to tear it apart.

[Management in the intensive care unit: between indications, constraints and contradictions]. / Prise en charge en chambre de soins intensifs: entre applications, contraintes et contradictions.

A patient with a pervasive developmental disorder was treated in the intensive care room for over a year; the freedom to come and go is an inalienable human right. How can the gap between legislative framework and the world of psychotic deficit be filled? The apparent contradiction between appropriate psychiatric care and the clinical condition of a patient with severe TED and intellectual deficit and the recommendations of the High Authority of Health is addressed. Narrative account in this context.

Helping self-mutilating adolescents: descriptions of Finnish nurses.

This study focused on the views of Finnish nurses in regards to providing help for adolescents who self-mutilate. Nine nurses participated, and when the interviews and written descriptions were qualitatively analysed, four main categories of information emerged. The first category comprises the nurses' views on self-mutilation. The second category describes the people who are able to be helpers. The third category describes the content of help, which is made up of a variety of acts provided by non-health professionals that promote the healthy development of adolescents. The fourth category describes care provided by nurses to adolescents who self-mutilate. Guidelines for caring for self-mutilating adolescents are needed, including information on the phenomenon of self-mutilation.

A concept analysis of suicidal behavior.

OBJECTIVE: Suicidal behavior is a significant global public health problem. Despite this, many health care professionals remain unaware of the distinction among suicidal behavior, self-mutilation, and deliberate self-harm. The aim of this study was to conduct a concept analysis of suicidal behavior. METHOD: Walker and Avant's 8-step method of concept analysis was used to examine the concept of suicidal behavior. Sources for analysis were identified using a systematic search of Medline, CINAHL, ProQuest Nursing & Allied Health Source, and the reference lists of related journal articles. RESULTS: Suicidal behavior was found to be associated with a constellation of external hazards and internal crises, lack of coping mechanisms and social support structures, and degree of suicidal intent, which, in the worst-case scenario, results in successful suicide. The antecedents of suicidal behavior are vulnerability characteristics that make painful events seem unbearable, and the consequences are death or failed suicide. In cases of failure, the medical consequences may be serious and long lasting. CONCLUSIONS: Defining the concept of suicidal behavior provides a basis for public health nurses to better understand suicidal behavior, thus improving their ability to care for suicidal patients during home visits.

Queimadura autoinfligida em mulheres: a violência de gênero inscrita no corpo / Self-inflicted burn on women: gender violence in scribed on the body

O objeto deste estudo consiste na violência autoinfligida em mulheres por queimadura. As lesões por queimadura são consideradas causas externas (acidentes e violências) e tem contribuído para o aumento geral dos índices de morbimortalidade acarretando perda de anos de vida produtiva. São resultantes de múltiplos fatores como condições socioeconômicas, violências e desigualdade de gênero. Esta pesquisa teve como objetivos: analisar o perfil sociodemográfico das mulheres que vivenciaram queimadura autoinfligida; descrever as circunstâncias e o contexto social relacionados à queimadura autoinfligida em mulheres; analisar os fatores motivadores da queimadura autoinfligida em mulheres; e, discutir a queimadura autoinfligida em mulheres na perspectiva de gênero. Trata-se de uma pesquisa de abordagem qualitativa e exploratória. Os cenários da pesquisa foram dois Centros de Tratamento de Queimados (Municipal e Federal) localizados no Estado do Rio de Janeiro. Os sujeitos do estudo foram 10 mulheres com história de queimadura autoinfligida e que não tivessem história de tentativa de suicídio anterior e diagnóstico de sofrimento psíquico, uma vez que estas situações poderiam comprometer a análise das vivências de violência. A coleta de dados foi realizada através de entrevista semi-estruturada, com roteiro previamente elaborado, no período de novembro de 2009 a março de 2010. Os dados foram analisados através da técnica de Análise de Conteúdo de Bardin, tendo emergido duas categorias: a) A vida da depoente antes da queimadura: percepção da sua condição pessoal; relações familiares envolvendo mãe, pai, avós, irmãos e filhos; relações sociais e relação com o companheiro; b) Queimadura autoinfligida em mulheres: uma questão de violência de gênero: fatores motivadores da queimadura autoinfligida na perspectiva da mulher e queimadura autoinfligida como desfecho da vivência de violência conjugal...

The object of this study is self-inflicted violence in women by burning. Burn injuries are considered external causes (accidents and violence) and have contributed to the overall increase in mortality rates resulting in loss of productive life. They are the result of multiple factors such as socioeconomic status, violence and gender inequality. This study sought to analyze the demographic profile of women who experienced self-inflicted burns; describe the circumstances and social context related to self-inflicted burning in women, analyze the factors which motivated self-inflicted burn in women, and discuss self-inflicted burns in women from a gender perspective. This is both a qualitative and an exploratory study. The research scenarios were two Burns Treatment Centers (Municipal and Federal) located in the State of Rio de Janeiro. The study subjects were 10 women with a history of self-inflicted burns who didn´t have a history of previous suicide attempts and diagnosis of psychological distress, since these situations could compromise the analysis of the experiences of violence. Data collection was conducted by means of a semi-structured interview with a predefined script, from November 2009 to March 2010. Data was analyzed with Bardin´s Content Analysis technique, and two categories have emerged: a) The life of the deponent before the burn: perceptions of her personal condition, family relations involving mother, father, grandparents, siblings and children; social relations and relationship with her partner, b) Self-inflicted burn in women: a matter of gender violence: motivating factors to self-inflicted burns from a woman's perspective and self-inflicted burns as an outcome of the experience domestic violence...

Best-practice intervention for care of clients who self-mutilate.

PURPOSE: To describe the development of a best practice intervention to guide nurse practitioners (NPs) who care for individuals who self-mutilate. DATA SOURCES: The evidence on which the guideline was based includes six descriptive studies and expert clinical opinion articles. The framework for development of the guideline is a systematic process to obtain and analyze the best available evidence, develop a theory-driven intervention, and propose a system for ongoing evaluation of the effectiveness of the intervention. CONCLUSIONS: The guideline is an information sheet, containing the definition of self-mutilation, background of the problem, target population affected, and intervention. The three components of the intervention are (a) the NP's self-evaluation of values, beliefs, and assumptions about individuals who self-mutilate; (b) a focused, in-depth assessment of the client; and (c) therapeutic strategies to address the emotional, social, and biological dimensions of self-mutilation. IMPLICATIONS FOR PRACTICE: This Best-Practice Intervention for Care of Clients Who Self-Mutilate guideline provides direction for NPs to address a preventable, self-injury behavior effectively. Further study is needed to examine the effectiveness of the use of the guideline and the intervention.

Culturally competent assessment and care of self-mutilation in urological nursing.

Use of self-mutilating behaviors as ineffective coping techniques is increasing, and it cuts across cultural and ethnic populations. With increasing immigration, the chance of facing both issues with a single patient is also increasing. Therefore, the need for assessment and care that is culturally sensitive is a necessity.

Concept analysis of self-mutilation.

AIM: This paper is a report of a concept analysis to define and describe self-mutilation. BACKGROUND: Although there has been an increased interest in self-mutilation, as evidenced by recent publication of opinion literature, anecdotal reports and a few clinical studies, the concept has not been well developed to guide nursing research and interventions. METHOD: Definitions and uses of self-mutilation were obtained in a comprehensive review of the health, psychology and education literature up to April 2007 to identify the defining attributes, antecedents and consequences. Walker and Avant's concept analysis strategy was the organizing framework. FINDINGS: Self-mutilation is the intentional act of tissue destruction with the purpose of shifting overwhelming emotional pain to a more acceptable physical pain. Antecedents of self-mutilation are impaired coping skills and an unhealthy response to situations that cause unbearable emotional stress. Limited research suggests that risk factors for self-mutilation may be White race, adolescent age, female sex and history of sexual abuse as a child. Although self-mutilation allows the individual to gain control over emotions and provides a diversion from emotional pain, a release of endorphins after the physical damage that contributes to the feeling of relief supports an addictive maladaptive coping cycle of pain, relief, shame and self-hate. CONCLUSION: The theoretical definition of the concept of self-mutilation offers the basis for nurses to develop interventions to provide competent care when discovering injuries that are self-inflicted.

Self-mutilation in adolescents.

Self-mutilation is not a new trend or phenomenon in adolescents. Self-mutilation can be divided into three categories: major, stereotypic, and moderate/superficial. Moderate/superficial self-mutilation is the most common type in adolescents and includes cutting, burning, and carving. School nurses are positioned to identify, to assist, and to educate adolescents who are self-mutilating, as well as those who may be at risk. A crucial intervention by school nurses is referral of students who are self-mutilating, because it is a gateway to treatment. Treatment, which includes therapy and medication, may be a difficult and lengthy process. The adolescent who self-mutilates may find the school environment difficult during treatment. School nurses must become educated about adolescent self-mutilation in order to care for those who engage in this behavior. Prevention of self-mutilation should focus on increasing coping mechanisms, facilitating decision-making strategies, encouraging positive relationships, and cultivating self-esteem.

No harm done.

People who take a drug overdose or otherwise harm themselves do not always receive a good reception in A&E. But in Kent an award-winning scheme is helping people to avoid the repetition of self-harming behaviour.

The language of cutting: initial reflections on a study of the experiences of self-injury in a group of women and nurses.

Non-suicidal self-injury is a distressing act, which can arouse dissent and negative comment in service users and providers. The purpose of the study was to describe how women who self-injure and nurses assign meaning to shared discourses about self-injury. The wider study is framed in a grounded theory methodology. Fourteen qualified nurses and 11 women who have self-injured were interviewed using unstructured and initially open-ended interviews, lasting 45-90 minutes. Initially a thematic analysis was used to code data. In this report, three of the early themes are reported with some comparative interpretations. Nurses lack understanding of the meanings of cutting behaviour. A common language is needed if nurses are to be effective in helping women who have self-injured to express distress in less damaging ways.

Understanding those who self-mutilate.

Self-mutilating behavior is a symptom seen in both men and women with various psychiatric disorders, but the majority of those who self-mutilate are women with borderline personality disorder. This complex, maladaptive behavior is used by clients as a means of self-preservation and emotion regulation, and is often associated with childhood trauma. Clients who self-mutilate perceive they receive poor care in hospital emergency departments and are retraumatized by these experiences. Clinicians who understand the complexity and purposes of self-mutilating behavior are better able to provide clients with supportive, empathetic care.

Living on the edge: the current phenomenon of self-mutilation in adolescents.

The purpose of this article is to share current knowledge about adolescent self-mutilation (SM), and to discuss treatment approaches for affected teens and young adults. One in eight American teenagers experiences depression or anxiety. The growing phenomenon of SM is a particularly worrisome coping mechanism used by teens and young adults to deal with stress and sadness. The incidence of SM is increasing, and might be fueled by current trends in music and media that highlight violent and self-injurious behaviors. SM represents a "cry for help" by adolescents who are suffering. Self-mutilators who repeatedly cut themselves with razors, scissors, knives, or sharp glass are not attempting suicide, but are seeking to relieve extreme anxiety, tension, or pain. Medical literature regarding SM is limited, and evidence-based treatment approaches have not been documented; however, early discovery of SM and the development of a multifaceted treatment approach that incorporates the child, family, and trusted practitioners could be instrumental in managing SM. There is hope that antidepressant medications may also be beneficial. Research is needed to identify successful treatment approaches, and to discover the best ways to educate teens, families, educators, and community leaders about the prevalence of SM in our youth.