1
|
Rodwell D, Frith H. 'A ward full of emotional, aggressive people': Social climate and interpersonal relationships in forensic settings caring for patients with borderline personality disorder. Int J Ment Health Nurs 2024. [PMID: 38400517 DOI: 10.1111/inm.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Therapeutic relationships play a central role in maintaining a positive social climate in forensic settings. The interpersonal difficulties characteristic of Borderline Personality Disorder, alongside the secure environment of forensic wards, can make developing positive therapeutic relationships with this patient group challenging. Qualitative interviews aimed to explore how ward staff understand and experience the interaction of interpersonal relationships and social climate when caring for patients with Borderline Personality Disorder on forensic wards. Interviews with 11 staff members working across UK forensic inpatient settings were analysed using Reflexive Thematic Analysis and reported following COREQ guidelines. Six interrelated themes were generated; three describe relational cycles that occur between ward staff and patients with Borderline Personality Disorder and three describe systemic factors that influence the context in which ward staff operate. From these themes, an integrative model was developed to summarise how factors in the wider forensic system and the interpersonal relationships between staff and patients with Borderline Personality Disorder in forensic wards influence one another, affecting staff experiences of the social climate of forensic settings. The model illustrates how complex cycles within the therapeutic relationships with staff and patients with Borderline Personality Disorder can interact with systemic influences in the wider forensic context to influence staff experiences of forensic settings. Clinical implications of the model are discussed, offering recommendations for improving therapeutic relationships and the social climate on forensic wards caring for patients with Borderline Personality Disorder, to better support staff and patient wellbeing.
Collapse
Affiliation(s)
- Devon Rodwell
- School of Psychology, University of Surrey, Guildford, UK
| | - Hannah Frith
- School of Psychology, University of Surrey, Guildford, UK
| |
Collapse
|
2
|
Jeong H, Jin MJ, Hyun MH. Understanding a Mutually Destructive Relationship Between Individuals With Borderline Personality Disorder and Their Favorite Person. Psychiatry Investig 2022; 19:1069-1077. [PMID: 36588441 PMCID: PMC9806505 DOI: 10.30773/pi.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Individuals with borderline personality disorder (BPD) commonly have a favorite person (FP), whom they are heavily emotionally attached to and dependent on. This study aims to identify and illustrate the patterns of destructive FP relationships based on actual experiences described by those with BPD. METHODS A data mining process was conducted using raw data collected from online communities, such as blogs and social networks. An in-depth review of the information to better understand the natural course of the FP relationship was also conducted. RESULTS Individuals with BPD form an intense and insecure attachment toward their FP, from which they enormously suffer. FPs can be their friends, romantic or life partners, or family members. As their feelings go beyond their control, being increasingly obsessed with their FP, they make their FP gradually lose hope in continuing the relationship and want to quit trying to fulfill their needs. The relationship finally ends when the FP stops being responsible for meeting their expectations and eventually drifts away. CONCLUSION This study suggests that certain FPs, distinctively named Teddy Bear Person, may behave in a particular manner to increase the likelihood of the FP relationship becoming more destructive. Moreover, the rejection sensitivity model should be discussed to understand their dysfunctional interaction.
Collapse
Affiliation(s)
- Hyorim Jeong
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Min Jin Jin
- Division of Liberal Arts, Kongju National University, Gongju, Republic of Korea
| | - Myoung Ho Hyun
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| |
Collapse
|
3
|
Wu T, Hu J, Davydow D, Huang H, Spottswood M, Huang H. Demystifying borderline personality disorder in primary care. Front Med (Lausanne) 2022; 9:1024022. [PMID: 36405597 PMCID: PMC9668888 DOI: 10.3389/fmed.2022.1024022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Borderline personality disorder (BPD) is a common mental health diagnosis observed in the primary care population and is associated with a variety of psychological and physical symptoms. BPD is a challenging disorder to recognize due to the limitations of accurate diagnosis and identification in primary care settings. It is also difficult to treat due to its complexity (e.g., interpersonal difficulties and patterns of unsafe behaviors, perceived stigma) and healthcare professionals often feel overwhelmed when treating this population. The aim of this article is to describe the impact of BPD in primary care, review current state of knowledge, and provide practical, evidence-based treatment approaches for these patients within this setting. Due to the lack of evidence-based pharmacological treatments, emphasis is placed on describing the framework for treatment, identifying psychotherapeutic opportunities, and managing responses to difficult clinical scenarios. Furthermore, we discuss BPD treatment as it relates to populations of special interest, including individuals facing societal discrimination and adolescents. Through this review, we aim to highlight gaps in current knowledge around managing BPD in primary care and provide direction for future study.
Collapse
Affiliation(s)
- Tina Wu
- Warren Alpert Medical School, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- *Correspondence: Tina Wu,
| | - Jennifer Hu
- Duke University Hospital, Durham, NC, United States
- Jennifer Hu,
| | | | - Heather Huang
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Margaret Spottswood
- Community Health Centers of Burlington, Burlington, VT, United States
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, United States
| | - Hsiang Huang
- Cambridge Health Alliance, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
| |
Collapse
|
4
|
Zarotti N, Hudson C, Human H, Muratori G, Fisher P. 'It's working together with what you've got': Healthcare professionals' experiences of working with people with combined intellectual disability and personality disorder diagnoses. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1317-1326. [PMID: 35725900 PMCID: PMC9796244 DOI: 10.1111/jar.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND People with intellectual disability often receive diagnoses which may complicate their clinical care. Among these, personality disorder diagnoses are still considered contentious. Little is also known on the perspectives of staff caring for people with intellectual disability who have received a personality disorder diagnosis. METHODS Three focus groups were carried out to explore 15 healthcare professionals' subjective experiences of working with people with intellectual disability who also have a recorded additional diagnosis of personality disorder. Data were analysed through thematic analysis. FINDINGS Four overarching themes were identified: (a) diagnostic issues and the need for person-centred approaches; (b) challenges and adjustments to working with combined intellectual disability and PD diagnoses; (c) the importance of multidisciplinary team training, support, and cohesion; (d) provision issues and barriers to service access. CONCLUSIONS The themes are outlined in depth and a number of implications for clinical management and service improvement are discussed.
Collapse
Affiliation(s)
- Nicolò Zarotti
- Department of Clinical Psychology and Psychological TherapiesNorwich Medical School, University of East AngliaNorwichUK
| | - Clive Hudson
- Adult Community Learning Disability Service, SuffolkNorfolk and Suffolk NHS Foundation TrustLowestoftUK
| | - Hannah‐Rose Human
- Adult Community Learning Disability Service, SuffolkNorfolk and Suffolk NHS Foundation TrustLowestoftUK
| | - Greco Muratori
- Adult Community Mental Health ServiceNorfolk and Suffolk NHS Foundation TrustNorwichUK
| | - Paul Fisher
- Department of Clinical Psychology and Psychological TherapiesNorwich Medical School, University of East AngliaNorwichUK
| |
Collapse
|
5
|
Acres K, Loughhead M, Procter N. From the community to the emergency department: A study of hospital emergency department nursing practices from the perspective of carers of a loved one with Borderline Personality Disorder. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1789-1797. [PMID: 34469029 DOI: 10.1111/hsc.13558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/20/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Carers of loved ones with Borderline Personality Disorder (BPD) often present to Emergency Departments (ED) during acute crisis situations. The initial contact for the carer and consumer in distress is often an emergency nurse. By gaining a greater understanding of carers (18+) perspectives on ED nursing practices when consumers with BPD are requiring crisis support, knowledge about preferred and best practice can be gained. To obtain this knowledge, four semi-structured focus group interviews were undertaken with a purposive sample of 13 carers through existing carer networks. Transcripts were analysed thematically to identify shared experiences and perspectives across interviews. Four key themes emerged: challenges in accessing crisis support, the need for communication, stigmatising practices, and different levels of care. Findings highlight the ED is viewed as a frontline service which has the capacity to link with another specialist supports when in crisis. Despite this; Communication, confidentiality issues and stigmatising practices continue. The results of this study have implications for nursing practice in the ED, providing important insights that can potentially benefit the carer, consumer and the ED to improve the quality of care offered for people in crisis.
Collapse
Affiliation(s)
- Kristy Acres
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, , Clinical and Health Sciences, Adelaide, Australia
| | - Mark Loughhead
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, , Clinical and Health Sciences, Adelaide, Australia
| | - Nicholas Procter
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, , Clinical and Health Sciences, Adelaide, Australia
| |
Collapse
|
6
|
Taylor P. Challenging the Myth of "Attention Seeking" Women with Suicidality: A Grounded Theory Study about Applying Counter-Pressure to Manage System Entrapment. Issues Ment Health Nurs 2022; 43:613-624. [PMID: 35026123 DOI: 10.1080/01612840.2021.2014608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Some women who express suicidal intent and engage in non-lethal self-harm perceive that nurses and other health care workers label them as attention-seeking and manipulative. An understanding of women's help-seeking behaviors that challenges suicide myths is presented. The purpose of this study was to examine help-seeking for suicidality in women with histories of intimate partner violence using a multiple qualitative research design of grounded theory and photovoice. Women from New Brunswick, Canada, over the age of 19 who left an abusive partner (n = 32) were interviewed and seven local women from this sample participated in five photovoice group sessions where they collectively examined self-generated photos of their experiences. Transcripts of the interviews and group sessions were analyzed using the constant comparative approach, yielding a theoretical rendering of women's help seeking. Results include a process of Applying Counter-Pressure as a way of pushing back against System Entrapment, or the sense of being invalidated and dehumanized by health care providers with the goal to Feel Human. Findings provide an understanding of women's behavior when seeking help for suicidality and may reduce nurses' assumptions and judgments when providing care. Trauma and violence informed care provides a framework from which to guide interventions that acknowledge the role of past and ongoing trauma in women's lives, supporting nurses' capacity to be validating and helping women to continue living.
Collapse
Affiliation(s)
- Petrea Taylor
- Faculty of Nursing, University of New Brunswick, Moncton, New Brunswick, Canada
| |
Collapse
|
7
|
McCarrick C, Irving K, Lakeman R. Nursing people diagnosed with Borderline Personality Disorder: 'We all need to be on the same hymn sheet'. Int J Ment Health Nurs 2022; 31:83-90. [PMID: 34562052 DOI: 10.1111/inm.12935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/16/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
The diagnosis of borderline personality disorder (BPD) has been found to carry stigma and poor hope of recovery. More recently, it has been regarded as a treatable condition through psychotherapy. Despite this, patients often experience lengthy hospitalizations, limited access to treatment, and poor outcomes. This paper describes the experiences of psychiatric nurses working with people diagnosed with BPD in acute mental health in-patient settings in Ireland. Seven nurses were interviewed, and the transcripts were analysed using a reflective and inductive approach. Overall, the nurses did not feel confident that their interventions were effective or valued by the wider service or patients. The nurses articulated their invidious professional circumstances, whereby they were required to act in ways, which ran counter to their vision of therapeutic or recovery-focused work. These views and perceptions that in-patient care is often ineffectual are widely echoed in the literature. We contend that the effect of this circumstance for these nurses approaches moral distress. The nurses were aware of more effective methods of care and treatment for BPD but perceived that they were unable to influence the culture of in-patient care.
Collapse
Affiliation(s)
| | - Kate Irving
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin 9, Ireland
| | - Richard Lakeman
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
| |
Collapse
|
8
|
Papathanasiou C, Stylianidis S. Experiences of Futility Among Nurses Providing Care to Patients With Borderline Personality Disorder in the Greek Mental Health System. J Psychosoc Nurs Ment Health Serv 2021; 60:33-42. [PMID: 34846225 DOI: 10.3928/02793695-20211119-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the current study was to explore mental health nurses' experiences and attitudes toward patients with borderline personality disorder (BPD) in Greece using a qualitative approach. Data were collected through two audio-recorded focus group discussions. Participants were 12 nurses who work in two general hospital psychiatric units and have direct clinical experience with patients with BPD. Audio recordings were transcribed verbatim and analyzed using thematic analysis in the context of grounded theory. One overarching theme and three main themes were identified. The overarching theme, Futility, refers to feelings that the provision of nursing care to patients with BPD is devoid of purpose and meaning. The main themes were: Uncertainty, Frustration, and Unsupportiveness. Of significance are nurses' feelings of frustration and futility creating a sense of being burdened and leading to negative attitudes and behaviors toward patients with BPD. Understanding treatment goals from the recovery model perspective and developing guidelines to help nurses revisit the concept of medical futility may improve care to patients with BPD. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
Collapse
|
9
|
Warrender D, Bain H, Murray I, Kennedy C. Perspectives of crisis intervention for people diagnosed with "borderline personality disorder": An integrative review. J Psychiatr Ment Health Nurs 2021; 28:208-236. [PMID: 32367638 DOI: 10.1111/jpm.12637] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with "BPD" often experience crisis and use services "BPD" is a controversial diagnosis, and the experience of crisis and crisis intervention is not well understood WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People diagnosed with "BPD" have different experiences of crisis, and using the diagnosis alone as a basis for deciding care and treatment is not appropriate There are many human factors which can influence how professionals deliver care to people diagnosed with "BPD" WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The education of staff, views on responsibility, team conflicts and access to clinical supervision can have an impact on how care is delivered, and should be addressed by organizations providing crisis care. Access to care often occurs when a person is self-harming or suicidal, but does not address underlying distress. Crisis care should go beyond managing behaviour and address any underlying needs. ABSTRACT: Introduction "Borderline personality disorder" ("BPD") is associated with frequent use of crisis intervention services. However, no robust evidence base supports specific interventions, and people's experiences are not well understood. Aim To explore the experiences of stakeholders involved in the crisis care of people diagnosed with "BPD." Method Integrative review with nine databases searched January 2000 to November 2017. The search filtered 3,169 titles and abstracts with 46 full-text articles appraised and included. Results Four themes were constructed from thematic analysis: crisis as a recurrent multidimensional cycle, variations and dynamics impacting on crisis intervention, impact of interpersonal dynamics and communication on crisis, and balancing decision-making and responsibility in managing crisis. Discussion Crisis is a multidimensional subjective experience, which also contributes to distress for family carers and professionals. Crisis interventions had limited and subjective benefit. They are influenced by accessibility of services, different understandings of "BPD" and human dynamics in complex decision-making, and can be experienced as helpful or harmful. Implications for practice Subjectivity of crisis experiences shows limitations of the diagnostic model of "BPD," emphasizing that interventions should remain person-centred. While thresholds for intervention are often met after self-harm or suicidality, professionals should review approaches to care and support people with underlying distress.
Collapse
Affiliation(s)
- Dan Warrender
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Heather Bain
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Ian Murray
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Catriona Kennedy
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| |
Collapse
|
10
|
Terpstra TL, Williamson S. Palliative Care for Terminally Ill Individuals With Borderline Personality Disorder. J Psychosoc Nurs Ment Health Serv 2019; 57:24-31. [PMID: 31188458 DOI: 10.3928/02793695-20190531-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/25/2019] [Indexed: 11/20/2022]
Abstract
Individuals with borderline personality disorder (BPD) exhibit persistent patterns of instability in mood, impulse control, self-image, and interpersonal relationships. These issues complicate quality end-of-life care for this population and are of particular concern for hospice and palliative care nurses and health care providers. This article presents case studies of terminally ill individuals with BPD as a series of vignettes that present common clinical issues encountered by the palliative care team. Interventions suggested in the literature as well as approaches used by team members when working with terminally ill individuals with BPD are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(9), 24-31.].
Collapse
|
11
|
Dickens GL, Lamont E, Mullen J, MacArthur N, Stirling FJ. Mixed‐methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder. J Clin Nurs 2019; 28:2613-2623. [DOI: 10.1111/jocn.14847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/26/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Emma Lamont
- School of Health and Social Sciences Abertay University Dundee UK
| | | | | | | |
Collapse
|
12
|
Green H. Team splitting and the ‘borderline personality’: a relational reframe. PSYCHOANALYTIC PSYCHOTHERAPY 2018. [DOI: 10.1080/02668734.2018.1487465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Huw Green
- Department of Psychiatry, Icahn School of Medicine at Mt Sinai, New York, USA
| |
Collapse
|
13
|
Abstract
SummaryOver the past decade attention to the provision of healthcare for individuals with personality disorder, particularly those who pose a risk to others, has substantially increased. Keeping pace with such developments with a suitably trained, consistent and motivated workforce, interfacing health and criminal justice systems where necessary, presents an enormous challenge. Staff must be experts in managing conflict at every level, while sustaining an optimistic and therapeutic orientation. Boundaried relationships provide the context for recovery for patients. Key principles and practices likely to promote resilience in personality disorder services, with a focus on the role of supervision, are outlined in order to support staff in keeping themselves afloat, their patients safe, and their services on target.
Collapse
|
14
|
Fleury MJ, Grenier G, Bamvita JM. Job satisfaction among mental healthcare professionals: The respective contributions of professional characteristics, team attributes, team processes, and team emergent states. SAGE Open Med 2017; 5:2050312117745222. [PMID: 29276591 PMCID: PMC5734453 DOI: 10.1177/2050312117745222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives The aim of this study was to determine the respective contribution of professional characteristics, team attributes, team processes, and team emergent states on the job satisfaction of 315 mental health professionals from Quebec (Canada). Methods Job satisfaction was measured with the Job Satisfaction Survey. Independent variables were organized into four categories according to a conceptual framework inspired from the Input-Mediator-Outcomes-Input Model. The contribution of each category of variables was assessed using hierarchical regression analysis. Results Variations in job satisfaction were mostly explained by team processes, with minimal contribution from the other three categories. Among the six variables significantly associated with job satisfaction in the final model, four were team processes: stronger team support, less team conflict, deeper involvement in the decision-making process, and more team collaboration. Job satisfaction was also associated with nursing and, marginally, male gender (professional characteristics) as well as with a stronger affective commitment toward the team (team emergent states). Discussion and Conclusion Results confirm the importance for health managers of offering adequate support to mental health professionals, and creating an environment favorable to collaboration and decision-sharing, and likely to reduce conflicts between team members.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,The Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Guy Grenier
- The Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Jean-Marie Bamvita
- The Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| |
Collapse
|
15
|
Kornhaber R, Haik J, Sayers J, Escott P, Cleary M, Cleary M. People with Borderline Personality Disorder and Burns: Some Considerations for Health Professionals. Issues Ment Health Nurs 2017; 38:767-768. [PMID: 28945490 DOI: 10.1080/01612840.2017.1367592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rachel Kornhaber
- a University of Tasmania , School of Health Sciences , Sydney , New South Wales , Australia.,b Department of Plastic and Reconstructive Surgery , National Burns Center, Sheba Medical Center , Israel
| | - Josef Haik
- b Department of Plastic and Reconstructive Surgery , National Burns Center, Sheba Medical Center , Israel.,c Sackler School of Medicine , Tel Aviv University , Israel
| | - Jan Sayers
- a University of Tasmania , School of Health Sciences , Sydney , New South Wales , Australia
| | - Phil Escott
- d Sydney Local Health District Mental Health Service , Sydney , New South Wales, Australia.,e University Associate in the School of Health Sciences at the University of Tasmania , Sydney , New South Wales , Australia
| | - Michelle Cleary
- a University of Tasmania , School of Health Sciences , Sydney , New South Wales , Australia
| | - Michelle Cleary
- a University of Tasmania , School of Health Sciences , Sydney , New South Wales , Australia
| |
Collapse
|
16
|
Abstract
Self-mutilation or cutting is not uncommon and may be detected in the workplace. It stems from an underlying psychological illness, specifically borderline personality disorder (BPD). Individuals diagnosed with BPD are usually attempting to handle negative childhood experiences and feelings of abandonment. They often overreact to social stress and engage in cutting to alleviate uncomfortable feelings. A small percentage go on to attempt suicide. Dialectical behavior therapy (DBT) is the preferred treatment modality for individuals with BPD. Occupational health nurses are in a pivotal position to identify workers who cut and to refer them to appropriate treatment options. In addition, occupational health nurses can learn to reinforce the social skills learned in DBT.
Collapse
|
17
|
Affiliation(s)
- Karrie Houghton
- Student mental health nurse, University of Central Lancashire
| | - Emma Jones
- Senior lecturer, mental health, School of Nursing, University of Central Lancashire
| |
Collapse
|
18
|
Clinical Observations About the Potential Benefits and Pitfalls of Between-Session Contacts with Borderline Patients. Harv Rev Psychiatry 2016; 24:e8-e14. [PMID: 27603746 DOI: 10.1097/hrp.0000000000000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Borderline Personality Disorder (BPD) has a reputation for being a challenging disorder to treat due to the nature of the illness. With the development of evidence-based treatments, therapists are becoming more skilled at successfully helping this cohort of patients. A common factor associated with all validated treatments for BPD is the active involvement of therapists. For example, DBT is one treatment where therapists are expected to be available to patients for coaching outside of sessions. However, understanding the benefits and pitfalls associated with therapists' accessibility in between sessions is relevant to any treatment with intersession contact. In this article, three benefits of intersession contact are described: to generalize the use of skills, to improve understanding of the patient's needs, and to facilitate an alliance. This article also addresses the pitfalls of therapists being so accessible to patients. Both the benefits and pitfalls of intersession contact are illustrated using case vignettes. Assessing the function served by a patient's contact in between sessions is an important way to determine whether such contact is a productive part of treatment. Recommendations are provided to avoid detrimental outcomes for both the therapist (therapist burnout) and the patient.
Collapse
|
19
|
Dehghani K, Nasiriani K, Salimi T. Requirements for nurse supervisor training: A qualitative content analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:63-70. [PMID: 26985224 PMCID: PMC4776562 DOI: 10.4103/1735-9066.174760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Supervisors should have certain characteristics and adequate preparation for their roles. Yet, there are no well-educated experts knowing about the supervisor's role and responsibilities and how to train them. So, this research was conducted with the purpose of finding the factors affecting nursing supervisor training. MATERIALS AND METHODS This research is an inductive content analysis. Participants were 25 in number, consisting of nurses and supervisors in Shahid Sadoughi University hospitals. The participants were chosen by a purposive sampling method. Data collection was done by semi-structured interviews and reviewing documents. Data were analyzed using conventional content analysis. RESULTS Findings included two main themes: Firstly, establishment of a supervisory infrastructure that includes "making the appointments and retention of supervisors, clarifying the duties and authority of supervisor, developing supervisory culture, specializing supervision, and conducting practice-based training" and secondly, comprehensive supervisory competencies that include "acquiring scientific, managing, communicative, professional, ethical, pedagogical, and supporting adequacy." CONCLUSIONS Clinical supervisor has a major role in ensuring the quality of nursing care. This leads to improvements in patient care and nurses' personal and professional development. So, it is necessary that for effective supervision in nursing, first an infrastructure is provided for supervision and then the comprehensive competency of a supervisor is enhanced to apply effective supervision.
Collapse
Affiliation(s)
- Khadijeh Dehghani
- Department of Nursing, Nursing and Midwifery School, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Khadijeh Nasiriani
- Department of Nursing, Nursing and Midwifery School, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Tahere Salimi
- Department of Nursing, Nursing and Midwifery School, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| |
Collapse
|
20
|
Eren N, Şahin S. An evaluation of the difficulties and attitudes mental health professionals experience with people with personality disorders. J Psychiatr Ment Health Nurs 2016; 23:22-36. [PMID: 26272790 DOI: 10.1111/jpm.12257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Working with people with a personality disorder (PD) can arouse strong feelings, and cause difficulties as well as different attitudes among mental health workers (MHWs). While attitudes towards people with PD and the difficulties experienced by MHWs have been previously investigated, the reciprocal relationship between the two has not been thoroughly investigated. AIM/QUESTION This study aims to investigate (1) affective reactions of MHWs to people with personality disorders, (2) the difficulties that MHWs experience while working with these patients, (3) their attitudes towards these patients, and (4) the interaction between these variables. METHOD The data for this study were collected through a Personal Information Questionnaire, the Difficulty of Working with Personality Disorders Scale and the Attitudes towards Patients with Personality Disorders Scale from 332 MHWs from several mental health clinics in Turkey, all of whom were experienced in working with people with PD. RESULTS The results indicate that the participants described 'difficulty in forming a relationship, understanding the client, and establishing cooperation' among the primary reasons of difficulties. This study also shows that there is a strong relationship between MHWs' feelings of boredom/discontent, guilt/pity and a tendency to display positive behaviours/an inability of establishing borders against people with PD. DISCUSSION The findings of this study imply that the level of education, expertise, psychotherapy treatment and clinical supervision of MHWs all affect perceived difficulties and attitudes towards people with PD. It is also noted that among nurses, a higher level of education results in reduced experience of difficulties while working with patients with PD. IMPLICATION FOR PRACTICE The results foreground the need for specific skills to be developed in MHWs through theoretical training, case-focused supervision and receiving personal psychotherapy for MHWs.
Collapse
Affiliation(s)
- N Eren
- Social Psychiatry Services, Department of Psychiatry, Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - S Şahin
- Department of Psychiatry, Faculty of Medicine, Istanbul University, İstanbul, Turkey
| |
Collapse
|
21
|
Warrender D. Staff nurse perceptions of the impact of mentalization-based therapy skills training when working with borderline personality disorder in acute mental health: a qualitative study. J Psychiatr Ment Health Nurs 2015; 22:623-33. [PMID: 26148873 DOI: 10.1111/jpm.12248] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 12/21/2022]
Abstract
People diagnosed with borderline personality disorder (BPD) are highly prevalent in acute mental health wards, with staff nurses identifying a challenge in working with people who can be significantly distressed. This has contributed to a negative stereotype verging on stigmatization. Mentalization-based therapy (MBT) is a psychological therapy which has been shown to be of benefit to people with a diagnosis of BPD, yet it has been utilized and evaluated only in partial hospitalization and outpatient settings. Despite this, most people diagnosed with BPD will continue to be treated in generic inpatient settings such as acute mental health. Mentalization-based therapy skills training (MBT-S) is a new and cost-effective 2-day workshop aiming to provide generalist practitioners with MBT skills for use in generic settings. This study aimed to capture staff perceptions of the impact of MBT-S on their practice when working with people with a diagnosis of BPD in acute mental health. Through two focus groups, this study assessed the perceptions of nine staff nurses. An interpretive phenomenological approach was utilized in data analysis. Participants found the approach easy to grasp, improving of consistency between staff and flexible in its use in planned or 'off the cuff' discussions. MBT-S promoted empathy and humane responses to self-harm, impacted on participants ability to tolerate risk and went some way to turning the negative perception of BPD through changing the notion of patients as 'deliberately difficult'. Staff felt empowered and more confident in working with people with a diagnosis of BPD. The positive implication for practice was the ease in which the approach was adopted and participants perception of MBT-S as an empowering skill set which also contributed to attitudinal change. In acute mental health environments, which may not have the resources to provide long-term structured treatments to patients, MBT-S could be viewed as ideal as participants applauded its flexibility. The promotion of empathy also sees a move away from iatrogenic damage caused by unhelpful responses to self-harm. In the context of wider research, this study shows that staff nurses find the MBT-S skill set valuable in the generic inpatient setting of acute mental health.
Collapse
Affiliation(s)
- D Warrender
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| |
Collapse
|
22
|
Reiss R, Gannon K. How do nurses experience working with adolescents with a diagnosis of 'personality disorder' or 'emerging personality disorder'? J Psychiatr Ment Health Nurs 2015; 22:244-50. [PMID: 25855395 DOI: 10.1111/jpm.12213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/27/2022]
Abstract
Nurses experience adults with a diagnosis of 'personality disorder' ('PD') as challenging, but nothing is known of their experiences working with young people with a diagnosis of 'PD' or 'emerging PD'. This study aimed to explore the experiences of nurses with this group. Six nurses were interviewed individually and the transcripts analysed employing interpretative phenomenological analysis. Two themes were identified: emotional impact, and conflict and need for support. Participants described powerful emotional responses and heavy time demands as particular challenges. They also reflected on tensions that arose in the wider team and service context. The importance of reflective space, training and the need for specialist approaches, such as therapeutic input, was emphasized by all participants. The study's findings suggest that while there are some similarities to adult services, there are also issues specific to nursing adolescents with 'PD', which merit further attention, including the implications of the lack of diagnostic clarity for treatment approaches and the difficult interpersonal dynamics of the condition. Recommendations for practice include additional training in relation to the theoretical understanding of diagnosis itself and in working therapeutically with young people with the diagnosis, employing approaches that have been found to be useful in adult services.
Collapse
Affiliation(s)
- R Reiss
- School of Psychology, University of East London, London, UK
| | | |
Collapse
|
23
|
Ekdahl S, Idvall E, Perseius KI. Family skills training in dialectical behaviour therapy: the experience of the significant others. Arch Psychiatr Nurs 2014; 28:235-41. [PMID: 25017556 DOI: 10.1016/j.apnu.2014.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/03/2014] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
Abstract
AIM The aim was to describe significant others' experiences of dialectical behaviour therapy-family skills training (DBT-FST), their life situation before and after DBT-FST, and measurement of their levels of anxiety and depressive symptoms. METHODS The study had a descriptive mixed method design. Data were collected with free text questionnaires (n=44), group interviews (n=53) and the HAD scale (n=52) and analysed by qualitative content analysis and descriptive and inferential statistics. RESULTS The results show that life before DBT-FST was a struggle. DBT-FST gave hope for the future and provided strategies, helpful in daily life. For the subgroup without symptoms of anxiety and depression before DBT-FST, anxiety increased significantly. For the subgroup with symptoms of anxiety and depression the symptoms decreased significantly. This indicates, despite increased anxiety for one group, that DBT-FST is a beneficial intervention and most beneficial for those with the highest anxiety- and depressive symptoms.
Collapse
Affiliation(s)
- Susanne Ekdahl
- Nyckeln Competence Center for Pedagogics in Healthcare, Kalmar County Hospital, S-391 85 Kalmar, Sweden; Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden.
| | - Ewa Idvall
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden; Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, SE-205 06 Malmö, Sweden
| | - Kent-Inge Perseius
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Red Cross University College, Box 55676, 102 15 Stockholm, Sweden
| |
Collapse
|
24
|
Stroud J, Parsons R. Working with borderline personality disorder: A small-scale qualitative investigation into community psychiatric nurses' constructs of borderline personality disorder. Personal Ment Health 2013; 7:242-53. [PMID: 24343967 DOI: 10.1002/pmh.1214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 07/07/2012] [Accepted: 07/26/2012] [Indexed: 11/11/2022]
Abstract
Borderline personality disorder (BPD) is a complex presentation that can have a significant impact upon the individual and on his or her quality of life. BPD has often been associated with negative connotations (e.g. 'manipulative', 'attention seeking'). The aim of the current study was to gain a fuller understanding of how community psychiatric nurses (CPNs) make sense of the diagnosis of BPD and how their constructs of BPD impact their approach to this client group. Four CPNs, three women and one man, were interviewed using a semi-structured interview schedule. The data were analysed using interpretative phenomenological analysis, to reveal over-arching and sub-themes. The results indicated that participants attempted to ascribe meaning to the client's presentation 'in the moment'. When they had a framework to explain behaviour, participants were more likely to express positive attitudes. When they did not have such a framework, participants could view clients in more pejorative terms. As participants were deriving meaning 'in the moment', there could be fluidity with regards to participants' attitudes, ranging from 'dread' to a 'desire to help'. This could lead to participants shifting between 'connected' and 'disconnected' interactions with clients. The limitations and implications for clinical practise will also be considered.
Collapse
Affiliation(s)
- James Stroud
- Hafan Hedd Resource Centre, Adpar, Newcastle Emlyn, SA38 9NS, UK
| | | |
Collapse
|
25
|
A life tiptoeing: being a significant other to persons with borderline personality disorder. Arch Psychiatr Nurs 2011; 25:e69-76. [PMID: 22114808 DOI: 10.1016/j.apnu.2011.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 06/07/2011] [Accepted: 06/24/2011] [Indexed: 11/23/2022]
Abstract
AIM The aim of this study was to describe significant others' experiences of living close to a person with borderline personality disorder and their experience of encounter with psychiatric care. METHODS Data were collected by free-text questionnaires and group interviews and were analyzed by qualitative content analysis. RESULTS AND CONCLUSION The results revealed four categories: a life tiptoeing; powerlessness, guilt, and lifelong grief; feeling left out and abandoned; and lost trust. The first two categories describe the experience of living close to a person with BPD, and the last two categories describe encounter with psychiatric care.
Collapse
|
26
|
|
27
|
Westwood L, Baker J. Attitudes and perceptions of mental health nurses towards borderline personality disorder clients in acute mental health settings: a review of the literature. J Psychiatr Ment Health Nurs 2010; 17:657-62. [PMID: 20712690 DOI: 10.1111/j.1365-2850.2010.01579.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- L Westwood
- Nursing Midwifery and Social Work The University of Manchester Manchester, UK
| | | |
Collapse
|
28
|
Purves D, Sands N. Crisis and triage clinicians' attitudes toward working with people with personality disorder. Perspect Psychiatr Care 2009; 45:208-15. [PMID: 19566693 DOI: 10.1111/j.1744-6163.2009.00223.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to investigate the attitudes of Australian psychiatric triage and crisis clinicians toward those with a diagnosis of personality disorder. DESIGN AND METHODS The design of the study was exploratory descriptive research. The study employed a survey method using Bowers and Allan's (2006) Attitude to Personality Disorder Questionnaire, which was designed to identify global attitudes toward those with a diagnosis of personality disorder. FINDINGS The findings of this study indicate that psychiatric crisis and triage clinicians hold negative attitudes toward those with a diagnosis of personality disorder. PRACTICE IMPLICATIONS Education and clinical supervision is required to address negative clinician attitudes.
Collapse
Affiliation(s)
- Deborah Purves
- Crisis Assessment Treatment Team, Inner West Area Mental Health, Moonee Ponds, Australia.
| | | |
Collapse
|
29
|
Ma WF, Shih FJ, Hsiao SM, Shih SN, Hayter M. 'Caring Across Thorns' - Different care outcomes for borderline personality disorder patients in Taiwan. J Clin Nurs 2009; 18:440-50. [DOI: 10.1111/j.1365-2702.2008.02557.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
30
|
Abstract
Clinical nurse specialists (CNSs) are essential to enhancing psychiatric-mental health nursing within state psychiatric hospital settings. This article presents a project focused on the CNSs in a state psychiatric hospital to expand their clinical role to increase the quality of care to individuals with serious mental illness and their numbers in other state psychiatric hospitals. As the patient population served in these settings becomes more complex, it is critical that advanced practice nurses are provided with appropriate updated state-of-the-art advanced knowledge and skills to collaborate within the interdisciplinary team. Furthermore, because of the complexity of the client and systems characteristics, the CNSs' clinical leadership is critical to promote the best practices in direct care services as well as provide support to various levels of nursing through staff development and training, role modeling, and mentoring of new staff.
Collapse
|
31
|
Perseius KI, Kåver A, Ekdahl S, Asberg M, Samuelsson M. Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms. J Psychiatr Ment Health Nurs 2007; 14:635-43. [PMID: 17880657 DOI: 10.1111/j.1365-2850.2007.01146.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the study was to investigate how starting to use dialectical behavioural therapy (DBT) in the work with young self-harming women showing symptoms of borderline personality disorder affected the psychiatric professionals (n = 22) experience of occupational stress and levels of professional burnout. The study was carried out in relation to an 18-month clinical psychiatric development project, and used a mix of quantitative and qualitative research methods [a burnout inventory, the Maslach burnout inventory-General Survey (MBI-GS), free format questionnaires and group interviews]. The result confirms previous reports that psychiatric health professionals experience treatment of self-harming patients as very stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients. The teamwork and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some therapists felt also improved their handling of other work stressors not related to DBT. The inventory for professional burnout, the MBI-GS, showed no significant changes over the 18-month period, although there was a tendency for increased burnout levels at the 6-month assessment, which had returned to baseline levels at 18 months.
Collapse
Affiliation(s)
- K-I Perseius
- Department of Clinical Neuroscience Psychiatry Center, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
32
|
Abstract
TOPIC This paper reviews the current literature on the nursing care of inpatients with borderline personality disorder (BPD). Information is included about the background and various features of BPD, and recent conceptualizations and predicted outcomes for BPD patients are provided. The effect of caring for patients with BPD on the nursing staff is discussed. CONCLUSIONS With proper education, support, and clinical supervision, the difficulties of caring for patients with BPD for the nursing staff can be reduced, and beneficial outcomes can be achieved for the staff and patients. NURSING IMPLICATIONS Patients with BPD can impact the entire multidisciplinary team. Understanding the dynamics of patients with BPD helps the staff to develop strategies to avoid splitting, acting-out behaviors, and negative impact on other patients and staff.
Collapse
Affiliation(s)
- Ann R Bland
- Eastern Kentucky University, Richmond, KY, USA.
| | | | | |
Collapse
|
33
|
Roche AM, Todd CL, O'Connor J. Clinical supervision in the alcohol and other drugs field: an imperative or an option? Drug Alcohol Rev 2007; 26:241-9. [PMID: 17454013 DOI: 10.1080/09595230701247780] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a growing interest in Clinical Supervision (CS) as a central workforce development (WFD) strategy. This paper provides a definition of and rationale for CS, characterises its various forms, identifies selection and training issues, and advises on policy and implementation issues central to redressing shortcomings in supervision practice within the alcohol and other drugs (AOD) field. Relevant selective literature is reviewed. Key conceptual issues were identified, and strategies developed to address implementation barriers and facilitate relevant policy. There is a common conceptual confusion between administrative supervision and CS. Clarification of the role, function and implementation of CS is required. Priority issues for the AOD field include: enhancing belief in CS; ensuring adequate resource allocation; developing evaluation protocols; and addressing specific arrangements under which supervision should occur. CS has been underutilised to date but holds considerable potential as a WFD strategy. It is fundamental to workers' professional development, can contribute to worker satisfaction and retention, and may improve client outcomes. Critical next steps are to establish the generalisability to the AOD field of the benefits observed from CS in other disciplines, and evaluate longer-term gains of CS programs.
Collapse
Affiliation(s)
- Ann M Roche
- National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide, Australia.
| | | | | |
Collapse
|
34
|
Wolf ZR, Robinson-Smith G. Strategies used by clinical nurse specialists in "difficult" clinician-patient situations. CLIN NURSE SPEC 2007; 21:74-84. [PMID: 17308442 DOI: 10.1097/00002800-200703000-00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to describe strategies used by clinical nurse specialists when caring for patients involved in "difficult" clinician-patient situations. Clinical nurse specialist members of the National Association of Clinical Nurse Specialists were surveyed to identify frequently used and high-priority strategies. Subjects (N = 234) identified strategies from a wide spectrum of activities, with agreement found between highest and lowest frequently used and priority approaches. Respect for the patient and ability to focus on the issue at hand emerged in the highest reported strategies.
Collapse
Affiliation(s)
- Zane Robinson Wolf
- La Salle University School of Nursing and Health Sciences, Philadelphia, PA, USA.
| | | |
Collapse
|
35
|
Katsuki F, Goto M, Takagi H, Ozdemir V, Someya T. Countertransference to psychiatric patients in a clinical setting: development of the Feeling Checklist-Japanese version. Psychiatry Clin Neurosci 2006; 60:727-35. [PMID: 17109707 DOI: 10.1111/j.1440-1819.2006.01588.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Countertransference is an important dimension of the therapeutic alliance between care providers and patients. The Feeling Checklist (FC) is a self-report questionnaire for the assessment of countertransference by hospital staff toward patients. The FC was translated from English into Japanese and its factor structure, reliability, and validity in the Japanese version (FC-J) were examined. A total of 281 Japanese psychiatric nurses were tested with the FC-J. All nurses were primarily involved in provision of psychiatric care. Principal-component factor analysis with varimax rotation was performed to identify the potential components of the FC-J. In a factor analysis of the FC-J, seven factors were extracted. The five subscales that were determined and labeled included Reject, Distance, Helpfulness, Closeness, and Involvement, which collectively accounted for 56.0% of the variance. Cronbach's alpha, a measure of internal consistency, for individual subscales was 0.833 for Reject, 0.763 for Distance, 0.768 for Helpfulness, 0.617 for Closeness, and 0.663 for Involvement. Notably, there was a significant correlation between the FC-J and the Nurse Attitude Scale (P < 0.0001). Moreover, one-way anova was performed with each FC-J subscale to examine differences among psychiatric diagnoses in the study sample. A significant difference was found for Involvement (P < 0.001), with the total score on Involvement being the highest in the personality disorder group. These results are considered to verify the reliability and validity of the FC-J as a scale to measure countertransference among Japanese care providers. The use of this scale allows individual care providers to recognize and be cognizant of their own countertransference objectively and thereby contributes to improve the relationship between patients and care providers.
Collapse
Affiliation(s)
- Fujika Katsuki
- School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan.
| | | | | | | | | |
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW To describe the prevalence and specific management of severe and complex personality disorders in community mental health services and similar settings. RECENT FINDINGS Conflicting reports exist in the literature but the consensus of evidence suggests that more complex personality disorder (more so than simple personality disorder) impairs response to treatment of most psychiatric disorders and complicates their management. Poor adherence to treatment may be one of the mechanisms underlying this. SUMMARY Increasing evidence now suggests that more complex and severe personality disorders have a negative impact on the outcome of most psychiatric disorders. Some indications, however, are there to show that pharmacological treatments may not handicap the outcome of pharmacological treatment as much as other types of intervention and may be selectively chosen in this group. Severe personality disorder needs to be identified early in community services as by anticipating and adjusting to its effects it is likely to improve treatment plans and prognosis.
Collapse
Affiliation(s)
- Peter Tyrer
- Department of Psychological Medicine, Imperial College, London, UK.
| | | |
Collapse
|