Exploring therapeutic engagement with individuals with a diagnosis of personality disorder in acute psychiatric inpatient settings: A nursing team perspective

Abstract

Individuals with a diagnosis of personality disorder (PD) face negative attitudes and are often deemed harder to care for than individuals with other diagnoses. To improve care and engagement with services, it is essential to understand the ways general psychiatric nursing staff approach this client group. This research aims to examine the ways inpatient psychiatric nursing staff therapeutically engage with individuals with a diagnosis of PD. Focus groups were conducted with Registered Mental Health Nurses (n = 7) and Health Care Assistants (formally known as nursing assistants; n = 12) who care for individuals with a diagnosis of PD in a general psychiatric inpatient setting. A thematic analysis indicated six themes: the right frame of mind, knowing the service user, knowing when to engage, service user input, a unified approach, and structured admissions. The findings highlight what non‐PD specialist inpatient nursing staff do in order to engage therapeutically with this group of service users and areas that require improvement. Supporting good practice could improve staff confidence when caring for this client group, lower stigma around the diagnosis, and promote a more positive experience of care for individuals with a diagnosis of PD who are using general inpatient mental health services.

Brief admission for patients with emotional instability and self‐harm: A qualitative analysis of patients’ experiences during crisis

“…Studies have reported that this skewed perception also extends to healthcare professionals who have a tendency to display negative attitudes towards this patient group and perceive them as manipulative (Westwood & Baker, 2010). Therefore, to improve inpatient care for this patient population, structured admissions with a clear goal including case management and discharge plans have been described as therapeutic (Acford & Davies, 2019). Acford and Davies (2019) also described that structured admissions are helpful for the staff and provided a framework on how to support patients in a constructive way.…”

“…Therefore, to improve inpatient care for this patient population, structured admissions with a clear goal including case management and discharge plans have been described as therapeutic (Acford & Davies, 2019). Acford and Davies (2019) also described that structured admissions are helpful for the staff and provided a framework on how to support patients in a constructive way.…”

Mental health nurses' measured attitudes to people and practice: Systematic review of UK empirical research 2000–2019

“…Short‐term positive change following educational intervention (Acford & Davies, 2019 [M]; Davies et al, 2014 [L]; Ebrahim et al, 2016 [M]; Lamph et al, 2018 [M]), ES+++ for “emotional reaction.” Evidence for sustained change hampered by low retention…”

“…There was ample evidence from studies that measured attitudes were amenable to change over the short term in relation to personality disorder (Acford & Davies, 2019 ; Davies et al, 2014 ; Dickens et al, 2018 ; Ebrahim et al, 2016 ; Lamph et al, 2018 ), self‐harm antipathy (Patterson et al, 2007a , 2007b ) and mental disorder/substance misuse co‐morbidity (Munro & Baker, 2007 ; Munro et al, 2007 ). Effect sizes for pre‐test to post‐test change were typically large except that for the Self‐Harm Antipathy Scale which was moderate.…”

“…Indeed, some studies simply assert that links between attitudes and practice are axiomatic. For example, Acford and Davies ( 2019 : p. 1177) state the common sense view that nurses report attitudes towards patients with a personality disorder diagnosis which “are likely to have a detrimental effect on the therapeutic engagement and care these individuals receive.” This may be true, but we consider it important to articulate the relevant theories about the underlying mechanisms behind such assertions.…”