What is a Self-injurious Behavior

The incident which I boast chosen for my Nursing purpose happened on the last day of my learning difficulties placement. It involved a unexampled Autistic man, who I allow for refer to as John passim my assignment. This is to protect the clients identity, this is in accordance with the UKCC Code of sea captain conduct (1992) cla uptake 10Protect all confidential discipline concerning patients and clients obtained in the course of professional practice and make disclosures only with consent, where undeniable by the order of a court or where you can loose disclosure in the wider public interest.One incident which I rely highlights the problem I will address, involved myself bathing John. This was not the first period 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 conduct by slapping his human face and then repeating the phrase stop slapping face. I chose this incident from my clinical diary as I witness that the self-injurious doings that John exhibited is an interesting and difficult Nursing problem and one, which abnormal my ability to c ar for him.Rather than focussing on the self-injury specifically related to Johns eccentric, I will examine the realistic shipway to deal out self-injurious behaviour, especially in persons with learning disabilities.To manage this problem effectively, a multi-disciplinary approach is required, alone for the purposes of this essay I will look at the problem from a Nurses perspective. I will stupefy by giving a brief description of self-injurious behaviour and the spirtable causes. I will then highlight the different techniques available to Nurses for the counselling of this behaviour. murphy and Wilson(1985) define this asAny behaviour initiated by the individual, which without delay results in physical harm to that individual.As is appargonnt in the literature, self-injurious behaviour is referred to a s any behaviour that can cause tissue damage, much(prenominal) as bruises, redness, and open wounds. The about common forms of these behaviours include head banging, slip by biting, head-slapping, and excessive scratching.There be two main sets of theories on the accede and these concentrate on physiological or social causes.The main physiological theories areSelf-injurious behaviour releases beta-endorphins in the persons brain. Beta-endorphins are opiate analogous substances in the brain, which provide the person with several(prenominal) pleasure when released.Sudden episodes of self-injury whitethorn be ca apply 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.May be cause by over arousal such as frustration. Self-injury acts as a release, and thusly lowers arousal.Self-injury may be a form of self-stimulatory, stereotypic behaviour. most wad exhibit se lf-injury to escape or avoid a task.Self-injurious behaviour may be used as an attention-seeking device.An incident that involved John which illustrated the impediment in managing self-injurious behaviour, was when an object he was obsessed with, was removed. This was using a penalty strategy which I will discuss later. This was thought to be the scoop out course of action, only it lead to John being restrained for approximately an hour, followed by him being sedated with an intra-muscular injection of chlorpromazine. What can learned from this is that it demonstrates the need for prudent assessment of the individual. As highlighted by Murphy and Wilson(1985)The intercession selected will reckon on how the self-injurious behaviour originally developed and what factors maintain it.There are a wide variety of different strategies or factors involved in treating or managing self-injurious behaviour. These include easiness, pharmacotheraphy, behavioral therapy, inter-personal strategies, normalisation and environmental factors. I will now examine in turn each of these strategies or factors.This is the most effective way of relations with self-injurious behaviour in an emergency but there are a number of problems that can arise.Firstly, restraint raises whatsoever ethical questions, such as does someone have the decline to prostitute themselves? This dilemna and others related to this topic are difficult to answer, but in world(a) we make the assumption that the client is not capable of choosing for themselves. Secondly, the use of restraint present devaluing images of the client. Thirdly, they involve the violation of personal space which is usual for terrestrial social interaction.This can lead to a detrimental effect on the nurse/client relationship. Furthermore, there is the risk of injury to staff and to the client. withal there is the possibility of staff being accused of abuse, this is highlighted by Jones and Eayrs(1993) precaution staff ma y well face allegations of client abuse associated with the use of restraint.There are some drawbacks in the use of restraint but it is an essential tool available to the Nurse in the management of Self-injurious or challenging behaviour.A number of drug treatments were used at Woodlands viz. Chlorpromazine and Hapliperidol. These were reasonably effective but with these drugs there are hard side cause. As stated by Bernstein et al(1994)Serious side effects include symptoms similar to those of Parkinsons disease, such as muscle rigidity, restlessness, earth tremor and slowed movement.These side effects can be treated with anti-Parkinson drugs.When trying to manage inappropriate behaviour using psychoactive drugs they should only be used as an integral part of the clients programme. For example to consent Pharamacotherapy with other strategies such as behavioural treatments.In general behavioural approaches to treatment seem to be the most effective and long unchanging ways of managing violent and aggressive behaviour. A reason for this is suggested by Murphy Wilson( )The fact that the learned behaviour hypothesis is one of the most win over hypotheses for explaining the development of self-injurious behaviour.This term covers a variety of different approaches but some of the main modes are positive reinforcement, modelling, extinction, aversive conditioning and punishment.This means, in the setting of my essay, reinforcing or strengthening any behaviour that is not self-injurious. An example of this is brocaded by Bernstein et al (1994) Autistic children, who, use very little language, were rewarded with grapes, popcorn, or other items for saying please, thank you and your welcome while exchanging crayons and blocks with a therapist.This is defined by Bernstein et al(1994) asThe gradual disappearance of a condition response or operand behaviour due to elimination either of the fellowship between conditioned and unconditioned stimuli or of rewards fo r certain behaviours.In the case of treating self-injurious behaviour it can be effective, but it is not always attainable to use this method, because, firstly the client may seriously injure himself in the beginning the behaviour disappears. Secondly, if the reason for the behaviour is self-stimulation, it may not be possible to remove the source of reinforcement.This is basically a method of therapy in which sought later on behaviours are demonstrated as a way of teaching them to clients.This method employs classical conditioning principles to link physical or psychological soreness with undesirable behaviours. An example of this by Bernstein et al(1994) isAlcoholics might be allowed to drink after taking a nausea-producing drug, so that the taste and smell of alcohol are associated with nausea rather than the usual pleasurable feelings.This was used extensively at woodlands. The main way in which clients were relaxed was through the use of a stunning room. This was basically a room that contained various lights, music and tactile objects intentional to relax the client. The sensory room was extremely effective at woodlands and was an invaluable apparatus in the management of violent or aggressive behaviour.This diverseness of strategy involves penalising any behaviour considered to be inappropriate. These were used at Woodlands, sometimes they were effective, but in one case regarding John it seemed to make matters worse, spark advance to him to require to be sedated. In general punishment strategies should be used in conjunction with reinforcement of desirable and non-injurious behaviours.This is an important strategy in the treatment of challenging behaviour. It is the way in which a Nurse communicates verbally or non-verbally with the client. It is recognised that inappropriate behaviour from tuitionrs can instigate or maintain aggressive behaviours. The important factors as indicated by my research are eye contact, posture, touch and how the nu rse actually speaks to the client. From my research I have found that there is a great deal of contradictory advice when dealing with an aggressive client. For example there is some evidence that remaining settle is the best thing to do but Breakwell(1989) cited by Jones and Eayrs(1993) suggests thatThe assailant who shouts is yelled at calm intensity is greeted with equal intensity.What is obvious is that when dealing with a client, interpersonal strategies are extremely important, but there is no right or wrong way.This is defined by Bank-Mikkelson (1980) cited by Murphy and Wilson(1985) as the need to Create an existence for the mentally retarded as squiffy to normal living conditions as possibleThis means to make conditions of education, housing, work and leisure to as near normal as possible and to give greater equality of rights, obligations and responsibilities under law. Although it is not necessarily related with the treatment of someone who presents challenging behaviou r, it is an important factor in considering the overall care of the client.This is providing an environment safe from potential factors, which may cause challenging behaviours. Some of these negative environmental factors may be things like loud noise, absence seizure of attention, aggression from other residents, isolation or not enough space.