Mental health services, care provision, and professional support for people diagnosed with borderline personality disorder: systematic review of service-user, family, and carer perspectives.

BACKGROUND: Mental health professionals' attitudes to people with Borderline Personality Disorder can be negative. No systematic review to date has examined how service-users and their families experience professional care. AIMS: To critically synthesise evidence of service-users' and families' subjective experience of mental health care for borderline personality disorder. METHODS: Multiple computerised databases were searched using comprehensive terms. All relevant, English language empirical studies were included. We read and critically assessed all papers independently. Study findings were subject to a meta-synthesis. RESULTS: A total of 38 studies were included. Analysis revealed four themes for service-users: assessment and diagnosis; approach of professionals; therapeutic interventions, and service provision; two broad themes for family/carers: support, burden, and information; and experience of professional and therapeutic approaches. Both groups expected to receive professional healthcare, and were clear they valued professionalism, respect, compassion and the therapeutic nature of positive relationships with professionals. Expectations were jeopardised where difficulties with knowledge, communication, information sharing, and support were perceived. CONCLUSIONS: Service-users and families/carers should expect to receive high quality, fair and equal care. In light of current evidence, a cultural shift towards more relational, person centred and recovery-focused care could improve experiences.

Mixed-methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder.

AIMS AND OBJECTIVES: To evaluate and explore mental health nurses' responses to and experience of an educational intervention to improve attitudes towards people with a diagnosis of borderline personality disorder (BPD). Report findings are concordant with relevant EQUATOR guidelines (STROBE and COREQ). BACKGROUND: Attitudes towards people with a diagnosis of BPD are poorer than for people with other diagnoses. There is limited evidence about what might improve this situation. One intervention with reportedly good effect uses an underlying biosocial model of BPD. No previous intervention has been co-produced with an expert by experience. We developed and delivered a 1-day intervention comprising these elements. DESIGN: A mixed-methods design was used comprising prospective within-subjects cohort intervention and qualitative elements. Participants were mental health nursing staff working in inpatient and community settings in one NHS Board in Scotland, UK. METHODS: Measurement of cognitive and emotional attitudes to people with a diagnosis of BPD at pre- and postintervention (N = 28) and at 4-month follow-up. Focus groups were used to explore participants' experiences of the intervention (N = 11). RESULTS: Quantitative evaluation revealed some sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies and negative attitudes in general. Qualitative findings revealed some hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert by experience. CONCLUSIONS: Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. Participants provided contrasting messages about what they think will be useful. RELEVANCE TO CLINICAL PRACTICE: The study provides further evidence for incorporation of a biosocial model into staff training as well as the benefits of expert by experience co-production. Mental health nurses, however, believe that more well-resourced services are the key to improving care.

Student health professionals' attitudes and experience after watching "Ida's Diary", a first-person account of living with borderline personality disorder: Mixed methods study.

BACKGROUND: There is increasing interest in the use of commercial movies in nursing education, or "cinenurducation". There is a need for educational interventions which target mental health nurses' attitudes towards people with borderline personality disorder. OBJECTIVES: To investigate and evaluate the experience and effects of attendance at a screening of the movie Ida's Diary, a first-person account of living with borderline personality disorder. DESIGN: Mixed methods design comprising a within-subjects AB longitudinal survey, and a qualitative analysis of participant-generated data and researcher field notes from a World Café discussion group. SETTINGS: One university in Scotland. PARTICIPANTS: N = 66 undergraduate and postgraduate mental health nursing and counselling students. METHODS: Participants completed measures of cognitive and emotional attitudes towards, and knowledge about, people with borderline personality disorder before and after one of two film screenings. We conducted a World Café discussion group after the second screening. Resulting data were subject to a qualitative thematic analysis. RESULTS: Quantitative analysis revealed a five-factor cognitive and a single-factor emotional attitude structure. Cognitive-attitudinal items related to treatment deservingness and value of mixed treatment approaches improved across iterations. Total knowledge score did not change, but one item about borderline personality disorder as a precursor to schizophrenia received considerably more incorrect endorsement post-screening. Qualitative analysis revealed five themes: Facilitation and inhibition of learning; promotion but not satiation of appetite for knowledge; challenging existing understanding; prompting creativity and anxiety; and initiating thinking about the bigger picture. CONCLUSIONS: Participants found the film thought provoking; it increased their appetite for knowledge. Findings suggest that screening should be delivered in conjunction with more didactic information about borderline personality disorder.

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

AIMS AND OBJECTIVES: To establish whether mental health nurses responses to people with borderline personality disorder are problematic and, if so, to inform solutions to support change. BACKGROUND: There is some evidence that people diagnosed with borderline personality disorder are unpopular among mental health nurses who respond to them in ways which could be counter-therapeutic. Interventions to improve nurses' attitudes have had limited success. DESIGN: Systematic, integrative literature review. METHODS: Computerised databases were searched from inception to April 2015 for papers describing primary research focused on mental health nurses' attitudes, behaviour, experience, and knowledge regarding adults diagnosed with borderline personality disorder. Analysis of qualitative studies employed metasynthesis; analysis of quantitative studies was informed by the theory of planned behaviour. RESULTS: Forty studies were included. Only one used direct observation of clinical practice. Nurses' knowledge and experiences vary widely. They find the group very challenging to work with, report having many training needs, and, objectively, their attitudes are poorer than other professionals' and poorer than towards other diagnostic groups. Nurses say they need a coherent therapeutic framework to guide their practice, and their experience of caregiving seems improved where this exists. CONCLUSIONS: Mental health nurses' responses to people with borderline personality disorder are sometimes counter-therapeutic. As interventions to change them have had limited success there is a need for fresh thinking. Observational research to better understand the link between attitudes and clinical practice is required. Evidence-based education about borderline personality disorder is necessary, but developing nurses to lead in the design, implementation and teaching of coherent therapeutic frameworks may have greater benefits. RELEVANCE TO CLINICAL PRACTICE: There should be greater focus on development and implementation of a team-wide approach, with nurses as equal partners, when working with patients with borderline personality disorder.

Interventions to improve mental health nurses' skills, attitudes, and knowledge related to people with a diagnosis of borderline personality disorder: Systematic review.

OBJECTIVES: There is some evidence that mental health nurses have poor attitudes towards people with a diagnosis of borderline personality disorder and that this might impact negatively on the development of helpful therapeutic relationships. We aimed to collate the current evidence about interventions that have been devised to improve the responses of mental health nurses towards this group of people. DESIGN: Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. DATA SOURCES: Comprehensive terms were used to search CINAHL, PsycINFO, Medline, Biomedical Reference Collection: Comprehensive, Web of Science, ASSIA, Cochrane Library, EMBASE, ProQuest [including Dissertations/Theses], and Google Scholar for relevant studies. REVIEW METHODS: Included studies were those that described an intervention whose aim was to improve attitudes towards, knowledge about or responses to people with a diagnosis of borderline personality disorder. The sample described had to include mental health nurses. Information about study characteristics, intervention content and mode of delivery was extracted. Study quality was assessed, and effect sizes of interventions and potential moderators of those interventions were extracted and converted to Cohen's d to aid comparison. RESULTS: The search strategy yielded a total of eight studies, half of which were judged to be methodologically weak with the remaining four studies judged to be of moderate quality. Only one study employed a control group. The largest effect sizes were found for changes related to cognitive attitudes including knowledge; smaller effect sizes were found in relation to changes in affective outcomes. Self-reported behavioural change in the form of increased use of components of Dialectical Behaviour Therapy following training in this treatment was associated with moderate effect sizes. The largest effect sizes were found among those with poorer baseline attitudes and without previous training about borderline personality disorder. CONCLUSIONS: There is a dearth of high quality evidence about the attitudes of mental health nurses towards people with a diagnosis of borderline personality disorder. This is an important gap since nurses hold the poorest attitudes of professional disciplines involved in the care of this group. Further work is needed to ascertain the most effective elements of training programmes; this should involve trials of interventions in samples that are compared against adequately matched control groups.

Understanding the art of feminist pedagogy: facilitating interpersonal skills learning for nurses.

The purpose of this study is to explore feminist pedagogy integrated with facilitation skills. A pedagogy project was undertaken with students participating in the BSc (Hons) Nursing programme, whereby a module, "Interpersonal Skills for Nurses" was developed for 72 year 1 students. A feminist pedagogy involves employing the powers of diversity to create an environment where all students' voices are heard. It values the power of sharing to create a community of learners in which teachers and students share their talents, skills and abilities to enhance the learning of all (Chinn, 2001). An end of semester evaluation provided feedback which indicated this was a valuable module to teach year 1 student nurses. It highlighted that student nurses found the topic both interesting and relevant and felt it was taught in a way that promoted their personal development and identity as a nurse.