Self-Injurious Behavior

Introduction

The incident which I have chosen for my Nursing Project happened on the last day of my learning difficulties placement. It involved a young Autistic man, who I will refer to as ‘John’ throughout my assignment. This is to protect the client’s identity, this is in accordance with the UKCC Code of professional conduct (1992) clause 10:

“Protect all confidential information concerning patients and clients obtained in the course of professional practice and make disclosures only with consent, where required by the order of a court or where you can justify disclosure in the wider public interest.';

One incident which I believe highlights the problem I will address, involved myself bathing ‘John’. This was not the first time that I had bathed a person during the placement, however, the difference this time was that while I was washing ‘John’, he would display elf-injurious behaviour by slapping his face and then repeating the phrase ‘stop slapping face’. I chose this incident from my clinical diary as I feel that the self-injurious behaviour that ‘John’ exhibited is an interesting and difficult Nursing problem and one, which affected my ability to care for him.

Rather than focussing on the self-injury specifically related to ‘John’s’ case, I will examine the possible ways to manage self-injurious behaviour, especially in persons with learning disabilities.

To manage this problem effectively, a multi-disciplinary approach is required, but for the purposes of this essay I will look at the problem from a Nurse’s perspective. I will begin by giving a brief description of self-injurious behaviour and the possible causes. I will then highlight the different techniques available to Nurses for the management of this behaviour.

Self-injurious behaviour

Murphy and Wilson(1985) define this as:

“Any behaviour initiated by the individual, which directly results in physical harm to that individual.';

As is apparent in the literature, self-injurious behaviour is referred to as any behaviour that can cause tissue damage, such as bruises, redness, and open wounds. The most common forms of these behaviours include head banging, hand biting, head-slapping, and excessive scratching.

There are two main sets of theories on the subject and these concentrate on physiological or social causes.

The main physiological theories are:

 Self-injurious behaviour releases beta-endorphins in the person’s brain. Beta-endorphins are opiate like substances in the brain, which provide the person with some pleasure when released.

 Sudden episodes of self-injury may be caused by sub-clinical seizures. Sub-clinical seizures are not typically associated with the behaviours of normal seizures by they are characterised by abnormal EEG patterns.