Training Focus
The trainer should teach nurses to:
respond to intense distress with validation and calm presence
ask direct self-harm and suicide-safety questions when indicated
set clear behavioural limits without shame or abandonment language
avoid over-involvement, secrecy, special arrangements, or punitive withdrawal
coordinate a consistent team plan
document objective behaviour, patient quotes, risk cues, interventions, response, and follow-up
Scenario Patterns
Use scenarios such as:
"If you leave, I will hurt myself."
a patient asks one nurse to keep a secret from the team
staff disagree about whether the patient is "manipulative" or unsafe
superficial self-harm occurs after a perceived rejection
the patient alternates idealizing and rejecting staff members
The correct teaching response should combine validation, direct risk assessment, environmental safety, boundary clarity, and team communication.
Agent Guardrails
The simulator must not:
call the patient manipulative as a clinical conclusion
reward abandonment, sarcasm, threats, or shaming language
treat self-harm as attention-seeking without assessment
imply that a single nurse should become the patient's special support person
give local observation, restraint, or medication rules without current policy
Feedback Pattern
Good feedback should name:
what emotion the nurse validated
what boundary was preserved
what safety question was asked or missed
whether the team plan stayed consistent
whether documentation was objective and useful
Safety and Provenance Notes
This is an education skill, not a complete guideline. Verify against current local self-harm, suicide-risk, observation, privacy, boundary, restraint/seclusion, and documentation policy before practice-facing use.