Clinical Supervision of Nurses Working With Patients With Borderline Personality Disorder

Bland, Ann R.; Rossen, Eileen K.

doi:10.1080/01612840590931957

Cited by 61 publications

(61 citation statements)

References 30 publications

(40 reference statements)

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“…The rise in the clinical acuity of caseloads means that allied health professionals are more frequently caring for patients with challenging situations (Bland & Rossen, 2005), while sometimes seeing little improvement in their patients' health conditions (Edwards & Burnard, 2003). Practicing in an ever-changing work environment (Sawbridge & Hewison, 2011) where there are uncertain health outcomes (Lloyd & King, 2001) are additional challenges associated with stress.…”

Section: Effectiveness Of Clinical Supervision and Burnoutmentioning

confidence: 99%

Clinical supervision, burnout and intent to leave: an Australian mixed methods study of community-based allied health professionals

Saxby¹

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ObjectiveClinical supervision is widely recognised for providing professional support, professional development and clinical governance for healthcare workers. Despite the growing uptake of clinical supervision, there have been few studies about the effectiveness of supervision for allied health professionals and fewer studies conducted within the Australian health context. This study aims to identify the perceived effectiveness of clinical supervision of allied health professionals in an Australian metropolitan community health setting. The study also sought to identify those factors that contribute to effectiveness and the relationship between clinical supervision effectiveness, burnout and intention to leave, as well as any profession-specific differences. MethodologyThe research has a two-phase, explanatory-sequential, mixed methods design. In Study 1, participants (n = 82) anonymously completed an on-line questionnaire, administered through the health service's intranet at 8 months post-implementation of the intervention, a structured model of clinical supervision. Study 2, commenced 12 months postimplementation and comprised several focus groups (n = 26), separately attended by supervisees (n = 15), and supervisors (n = 11). The sample was drawn from the population of allied health professionals (N = 120) who were receiving or providing supervision within the study location.The on-line questionnaire sought demographic data, work history and the number and length of supervision sessions. Clinical supervision effectiveness was operationalised using the Manchester Clinical Supervision Scale-26 (MCSS-26©); burnout was measured using the Maslach Burnout Inventory; and intention to leave was operationalised using the Intent to Leave Scale. ResultsEighty-two allied health professionals participated in Study 1, resulting in a 68% response rate. Ages ranged from 24 to 66 years, and females accounted for 89% (n = 71) of all respondents. The professions of occupational therapy, physiotherapy and social work together comprised 73% of the total number of participants. Twenty-six allied health ii professionals participated in the five focus groups of Study 2. All participants were female, with 81% belonging to the professions of occupational therapy, physiotherapy and social work.Overall, clinical supervision was perceived as effective. In the main, supervisee's responses illustrated that supervision provided effective professional support, education and guidance for professional practice.'Time', as well as specific procedural factors, were found to be important in relation to Significant associations were found between clinical supervision effectiveness and burnout and intention to leave. Highly efficacious supervision was significantly and negatively associated with Emotional Exhaustion and Depersonalization. In addition, higher scores on "Finding Time" were significantly correlated with lower scores of Emotional Exhaustion.Effective supervision was significantly and positively associated with Personal Accomp...

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Section: Effectiveness Of Clinical Supervision and Burnoutmentioning

confidence: 99%

Clinical supervision, burnout and intent to leave: an Australian mixed methods study of community-based allied health professionals

Saxby¹

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“…Because of the demanding, dependency, or actingout behavior of individuals with BPD, clinicians often become angry and non-therapeutic (Bland & Rossen, 2005;Sperry, 1999). Through knowledge and understanding, occupational health nurses can learn to view clients with BPD as individuals who are struggling with adaptively expressing their anger and negative emotions, instead of as disruptive and manipulative (Bland & Rossen, 2005).…”

Section: Characteristics Of Self-mutilatorsmentioning

confidence: 99%

“…Through knowledge and understanding, occupational health nurses can learn to view clients with BPD as individuals who are struggling with adaptively expressing their anger and negative emotions, instead of as disruptive and manipulative (Bland & Rossen, 2005). Newman (1997) emphasizes that clinicians should not break work policies to pacify clients with BPD.…”

Section: Characteristics Of Self-mutilatorsmentioning

confidence: 99%

Cutting

Hart

2007

AAOHN Journal

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mployees who come to occupational health clinics as self-mutilators or "cutters" prove challenging for occupational health nurses. These employees typically have feelings and emotions deeply embedded in their desire to harm themselves, usually by cutting or abrading the skin. The cutting is an effort to handle or control feelings and anxiety resulting from a past negative life experience (Mason & Kreger, 1998). Although this type of self-harm does not automatically lead to suicide, these individuals must be carefully screened for suicidal ideations. The underlying diagnosis of those who self-mutilate is borderline personality disorder (BPD), a psychiatric disorder characterized by a pervasive pattern of unstable interpersonal relationships and marked emotional impulsivity (Sperry, 1999). Current research provides some insight into this mounting cultural phenomenon. However, individuals have unique past experiences contributing to their destructive behavior and fueling their propensity to cut themselves (Linehan, 1993b). Occupational health nurses have a unique opportunity to foster trusting relationships with clients through daily interactions. These encounters may lead to the creation of a therapeutic relationship, which can be a catalyst for identifying and understanding clients who self-mutilate, ultimately facilitating appropriate intervention and referrals. This article defines and describes self-mutilation or cutting and proposes known theoretical frameworks for understanding the phenomenon. It discusses BPD, often the underlying psychological problem of these clients, as defined by the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 2000). It also describes treatment modalities, specifically dialectical behavior therapy (DBT), and proposes appropriate nursing interventions occupational health nurses can use in the workplace. Defining Self-MutilAtion or Cutting Self-mutilation or cutting is an extremely perplexing phenomenon that is becoming more frequent. An estimated 700 of every 100,000 individuals engage in some form of self-harm through mutilation (Dunkle, 1990; Froeschle & Moyer, 2004). The concept of self-mutilation has become somewhat blurred by more recent societal norms. Multiple tattoos and body piercings, once thought to be barbaric in nature, have become commonplace, making the distinction between self-mutilation and body adornment unclear (Froeschle & Moyer, 2004). According to Malon and Berardi (1987), cutting was first reported in the literature in 1960 and continues to be a prevalent mental health problem. Nurse clinicians and researchers often categorize self-mutilating acts in three ways (

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“…Wellfunctioning peer groups can provide safe and trustable working alliances. Bland & Rossen (2005) describe the role of clinical nurse specialists in the provision of group supervision for nursing teams working with people with borderline personality disorder, and the resultant enhancement of job satisfaction for all. A possible difficulty with peer supervision as the sole source of reflective practice is that it may exclude other professionals and increase the risk of splits in a multidisciplinary team.…”

Section: Peer Surpervisionmentioning

confidence: 99%

“…There is some clinical consensus that Cluster B personality disorders in particular (including psychopathy; Hare 1998) have a substantial impact on carers (National Institute for Mental Health in England 2003;Rigby 2004;Bland 2005;Perseius 2007). Staff can become the target of intolerable feelings (of guilt, anxiety, depression, jealousy, hostility, neediness).…”

Section: Declaration Of Interestmentioning

confidence: 99%

Personality disorder: its impact on staff and the role of supervision

Moore¹

2012

Adv. psychiatr. treat

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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.

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Clinical Supervision of Nurses Working With Patients With Borderline Personality Disorder

Cited by 61 publications

References 30 publications

Clinical supervision, burnout and intent to leave: an Australian mixed methods study of community-based allied health professionals

Clinical supervision, burnout and intent to leave: an Australian mixed methods study of community-based allied health professionals

Cutting

Personality disorder: its impact on staff and the role of supervision

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