Working with borderline personality disorder: A small‐scale qualitative investigation into community psychiatric nurses' constructs of borderline personality disorder

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.

Mental health nurses’ attitudes, behaviour, experience and knowledge regarding adults with a diagnosis of borderline personality disorder: systematic, integrative literature review

“…This polarisation was evident in studies where participants reported dread at going to work versus a desire to help, and understanding distress alongside setting boundaries (Nehls , Ma et al . , Stroud & Parsons ). ‘Being manipulative’ and ‘attention seeking’ were common terms used about the diagnostic group (Hazelton et al .…”

Når pasienten vekker det verste i deg

“…Undervisning og kunnskap kan skape denne forståelsesrammen. Når sykepleierne har et slikt rammeverk, kan holdningene bli mer positive (12). Dette rammeverket kan bestå av kunnskap om pasientenes ofte traumatiske bakgrunn, men også av miljøterapeutiske metoder som å skape allianse (12).…”

“…Høyt arbeidstempo og -press fremheves som noe av opphavet til negativiteten. Stroud og Parsons hevder at psykiatriske sykepleiere ofte er medisinsk orienterte, noe som usynliggjør de menneskelige aspektene (12). Til sammen kan arbeidspress og økt medisinsk orientering legge press på samhandlingen mellom kollegaer, noe som i sin tur kan gå ut over pasientene.…”

“…Avdelingskulturen har mye å si for hvordan holdninger formes og vedlikeholdes (12). På akuttpsykiatrisk avdeling er det nedfelt i reglene at de ansatte ikke skal gi personlige opplysninger om eget liv eller bakgrunn, og det skal vaere et klart skille mellom pasient og personale.…”

“…I Norge har cirka 1,2 prosent av befolkningen UPF (2). Det er utbredt og vel dokumentert at mange som arbeider med UPFpasienter, har negative holdninger overfor denne pasientgruppen (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Slike holdninger påvirker tydelig omsorgen som blir gitt, i negativ retning (13).…”