Reliability and Validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD Test.

BACKGROUND AND PURPOSE: The purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis. METHODS: This study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial. RESULTS: A total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions. CONCLUSIONS: Future use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.

Support, interventions and outcomes for families/carers of people with borderline personality disorder: A systematic review.

It is clear from existent literature that families and carers of relatives and friends with borderline personality disorder (BPD) experience high levels of burden. Whilst family interventions are considered vital to improving the outcomes of those with a range of mental health difficulties, there has been limited development of direct interventions for carers of people with BPD, despite a high level of need. This systematic review aimed to appraise and synthesize the existing research evidence for interventions for carers of people with BPD. Ten studies were included that were directly related to six interventions for families and carers of people with personality disorder. The findings of these studies, whilst limited, do provide some initial evidence that interventions for carers may lead to significant outcomes for the participants, particularly in improving carer well-being and reducing carer burden. © 2019 John Wiley & Sons, Ltd.

Palliative Care for Terminally Ill Individuals With Borderline Personality Disorder.

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.].

Nursing care for people with borderline personality disorder in the Freirean perspective. / Cuidado de enfermagem às pessoas com transtorno de personalidade borderline na perspectiva freireana.

OBJECTIVE: To understand, from the ethical perspective of Freire's, the nursing care for people with borderline personality disorder. METHODS: This is a qualitative research whose production of information was conducted from May to June 2016 in two psychiatric admission units. We have interviewed seven nurses and eight nursing technicians. The information was analyzed in the light of Paulo Freire's referential framework. RESULTS: The following categories have come up: 1) Welcoming and therapeutic relationship as instruments to strengthen linkage; and 2) Drug therapy and restraint: interface between protection, establishment of limits and other challenges for care". CONCLUSIONS: Nursing care involved technologies related, medicine administration and physical restraint. There were difficulties in dealing with this disorder. The way to care for nursing, although still permeated by some prejudices, runs through ideologies contained in the ethical assumptions that operate in the light of Freire's work.

A randomized controlled trial of a mentalization-based intervention (MBT-FACTS) for families of people with borderline personality disorder.

This article reports a delayed-treatment randomized controlled trial of a mentalization-based intervention for families or significant others living with or supporting a person with borderline personality disorder (BPD). In all, 56 family members/significant others living with/supporting people with a diagnosis of BPD were randomized either to immediate mentalization-based Families and Carers Training and Support, a supportive and skills-based program consisting of five 1.5- to 2-hr evening meetings, delivered by trained family members, or to delayed intervention. The primary outcome was adverse incidents reported by the family member in relation to the person with BPD. Secondary outcomes included self-reported family well-being, empowerment, burden, and levels of anxiety and depression. Family members randomized to immediate intervention showed a significant reduction in reported adverse incidents between themselves and the identified patient in the second phase of treatment compared with those randomized to delayed intervention. Analysis of the rate of change indicated a significantly steeper decline for the immediate-treatment group compared with the delayed-intervention group (ß = -1.07, 95% confidence interval [-1.40, -0.74], z = -6.3, p < .000). Secondary outcome measures showed family functioning and well-being improved more in the immediate-treatment group; changes were maintained at follow-up. There were no differences in depression, total anxiety, and total burden; both groups showed improvement on all these measures. Findings show that the mentalization-based Families and Carers Training and Support program delivered by families to families supporting a person with BPD reduces reported adverse incidents within the family. Further studies are needed to show whether this reduction improves outcomes for the individual with BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cuidado de enfermagem às pessoas com transtorno de personalidade borderline na perspectiva freireana / Atención de enfermería a personas con trastorno límite de la personalidad desde la perspectiva freireana / Nursing care for people with borderline personality disorder in the Freirean perspective

Resumo OBJETIVO Compreender, sob a perspectiva ética de Freire, o cuidado de enfermagem às pessoas com transtorno de personalidade borderline. MÉTODOS Pesquisa qualitativa cuja produção das informações foi realizada de maio a junho de 2016, em duas unidades de internação psiquiátrica. Foram entrevistados sete enfermeiros e oito técnicos de enfermagem. As informações foram analisadas à luz do referencial de Paulo Freire. RESULTADOS Emergiram as categorias: 1) Acolhimento e relacionamento terapêutico como instrumentos para fortalecimento de vínculo; e 2) Terapia medicamentosa e contenção: interface entre proteção, estabelecimento de limites e outros desafios para o cuidado. CONCLUSÕES Os cuidados de enfermagem envolveram tecnologias relacionais, administração de medicamentos e contenção mecânica. Foram referidas dificuldades para lidar com pessoas com esse transtorno. A maneira de cuidar da enfermagem, embora ainda permeada por alguns preconceitos, passa por ideários contidos nos pressupostos éticos que operam à luz da obra de Freire.

Resumen OBJETIVO Comprender, bajo la perspectiva ética de Freire, la atención de enfermería a personas con trastorno límite de la personalidad. MÉTODOS Investigación cualitativa, cuya producción de información se realizó de mayo a junio de 2016, en dos unidades de internación psiquiátrica. Se entrevistaron a siete enfermeras y ocho técnicos de enfermería. Se analizó la información a la luz del marco referencial de Paulo Freire. RESULTADOS Surgieron las categorías: 1) Acogida y relación terapéutica como instrumentos para el fortalecimiento del vínculo; y 2) Terapia medicamentosa y contención: interfaz entre protección, establecimiento de límites y otros desafíos para la atención. CONCLUSIONES La atención de enfermería incluyó tecnologías relacionales, administración de fármacos y contención física. Hubo dificultades para tratar con personas con este trastorno. La forma de cuidar de la enfermería, aunque esté aún impregnada por algunos prejuicios, pasa por ideologías contenidas en los supuestos éticos que operan a la luz de la obra de Freire.

Abstract OBJECTIVE To understand, from the ethical perspective of Freire's, the nursing care for people with borderline personality disorder. METHODS This is a qualitative research whose production of information was conducted from May to June 2016 in two psychiatric admission units. We have interviewed seven nurses and eight nursing technicians. The information was analyzed in the light of Paulo Freire's referential framework. RESULTS The following categories have come up: 1) Welcoming and therapeutic relationship as instruments to strengthen linkage; and 2) Drug therapy and restraint: interface between protection, establishment of limits and other challenges for care". CONCLUSIONS Nursing care involved technologies related, medicine administration and physical restraint. There were difficulties in dealing with this disorder. The way to care for nursing, although still permeated by some prejudices, runs through ideologies contained in the ethical assumptions that operate in the light of Freire's work.

Case Study Application for Psychopharmacology With Borderline Personality Disorder.

Using an evolving case study, the current article demonstrates the principles of working with a client who has borderline personality disorder in relation to medications. The case study poses questions for the reader to consider and answers at the end of the article. [Journal of Psychosocial Nursing and Mental Health Services, 56(5), 16-19.].

Borderline personality disorder and the ethics of risk management: The action/consequence model.

Patients with borderline personality disorder are frequent users of inpatient mental health units, with inpatient crisis intervention often used based on the risk of suicide. However, this can present an ethical dilemma for nursing and medical staff, with these clinician responses shifting between the moral principles of beneficence and non-maleficence, dependent on the outcomes of the actions of containing or tolerating risk. This article examines the use of crisis intervention through moral duties, intentions and consequences, culminating in an action/consequence model of risk management, used to explore potential outcomes. This model may be useful in measuring adherence and violation of the principles of beneficence and non-maleficence and therefore an aid to clinical decision making.

[Anorexia and borderline personality disorder : bonds pathology]. / Anorexie mentale et trouble borderline : une pathologie du lien.

Comorbidity with a borderline personality disorder is far from rare in patients suffering from eating disorders. Clinically, this presents as chronic instability in many areas: interpersonal relationships, self-image, emotions, mood and acting out. Treatment is mainly based on a containing and reassuring therapeutic framework. A care plan may be put in place that incorporates reducing impulsive harmful, eating and self-harming behaviours. Dialectical behaviour therapy is intended in particular to prevent suicide risk in borderline personality disorder patients.

Percepção dos enfermeiros frente ao atendimento a portadores de transtorno de bordeline / Perception of nurses towards the care of patients with borderline disorder

O objetivo do presente artigo é avaliar o conhecimento dos enfermeiros da atenção básica, frente às ações relacionadas ao atendimento ao paciente com Transtorno de Personalidade de Borderline. Tratou-se de um estudo exploratório-descritivo, de abordagem qualitativa, coleta de dados por meio de entrevista com questionário elaborado pelos autores e análise de conteúdo para análise dos dados. Participaram da pesquisa sete enfermeiros, onde foi possível considerar que é superficial o conhecimento referente ao Transtorno de Borderline, para a maioria dos entrevistados, com ações de cuidado voltadas ao acolhimento...

The purpose of this article is to evaluate the knowledge of primary care nurses in the actions related to the care of patients with Borderline Personality Disorder. This was an exploratory-descriptive study of qualitative approach, data collection through interviews with questionnaire developed by the authors and content analysis for data analysis. The participants were seven nurses, it was possible to consider it superficial knowledge regarding the Borderline Disorder, for most respondents, careful actions to host...

El propósito de este artículo es evaluar el conocimiento de las enfermeras de atención primaria en las acciones relacionadas con el cuidado de los pacientes con trastorno límite de Ia personalidad. Este fue un estudio exploratorio-descriptivo de enfoque cualitativo, la recopilación de datos a través de entrevistas con cuestionario desarrollado por los autores y análisis de contenido para el análisis de datos. Los participantes fueron siete enfermeros, era posible considerar que un conocimiento superficial con respecto ai trastorno límite, para la mayoría de los encuestados, las acciones cuidadosas ai anfitrión...

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.

Evidence-Based Care of the Patient with Borderline Personality Disorder.

Borderline personality disorder (BPD) is a complex, serious, and high-cost psychiatric disorder. The high prevalence of patients with BPD and co-occurring depression, eating disorders, and substance-use disorders in primary care and mental health settings contribute to their high use of resources in these practice settings. Regardless of treatment challenges associated with BPD, researchers suggest a more positive outlook in the treatment of this complex psychiatric condition. This article focuses on areas in which nurses can strengthen their understanding of underpinnings and multimodal approaches, assess the patient's immediate needs, and manage distressful emotional states and impulsivity.

Traduciendo la corporalidad adolescente. Caso clínico / Translating adolescent corporality. A clinical case

El propósito de este trabajo es, por un lado, la descripción de un caso clínico que supone una aportación importante al conocimiento del proceso de enfermedad en una adolescente con trastorno mental grave y, por otro lado, exponer la metodología enfermera de Salud Mental en los programas tan particulares y específicos como son las Unidades Terapéuticas Educativas. Se trata de una adolescente de 15 años que es derivada a la Unidad Terapéutica Educativa (UTE), por un lado, para que consiga alcanzar una mayor estabilización clínica y evitar los frecuentes pasajes al acto que realiza y, por el otro, intentar que se reenganche a la dinámica educativa. Está diagnosticada de trastorno de la conducta alimentaria sin especificar (F50.9) y de trastorno límite de personalidad (F60.3).Los cuerpos enfermos de los adolescentes que padecen trastornos mentales graves se convierten en muchos casos en el vínculo que mantiene la relación con Enfermería, ya que en pacientes con escasa mentalización es el único vínculo posible

The purpose of this article is, on one hand, to describe a clinical case which represents a major contribution to the knowledge of the disease process in an adolescent girl with severe mental disorder, and on the other hand, to explain Mental Health nursing methodology in programs as particular and specific as Educational Therapeutic Units. A 15-year-old female adolescent is referred to the Educational Therapeutic Unit (ETU) with the aim of achieving a higher clinical stabilization and preventing frequent relapses into the act she conducts, as well as trying to make her return to educational dynamics. She has a diagnosis of unspecified eating disorder (F50.9)and borderline personality disorder (F60.3).The sick bodies of those adolescents who suffer severe mental disorders will become in many cases the link that sustains their relationship with nurses, because this is the only possible link in patients with a low level of awareness

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.

Experiences of family carers of people diagnosed with borderline personality disorder.

There is limited understanding of the experience of family carers of people diagnosed with borderline personality disorder (BPD). This study aimed to explore their experiences of being carers, their attempts to seek help for the person diagnosed with BPD and their own carer needs. An invitation to participate in an online survey was distributed to carers across multiple consumer and carer organizations and mental health services, by the Private Mental Health Consumer Carer Network (Australia) in 2011. Responses from 121 carers showed that they experience significant challenges and discrimination when attempting to engage with and seek support from health services. Comparison with consumers' experiences (reported elsewhere) showed that these carers have a clear understanding of the discrimination faced by people with this diagnosis, largely because they also experience exclusion and discrimination. Community carer support services were perceived as inadequate. General practitioners were an important source of support; however, they and other service providers need more education and training to support attitudinal change to address discrimination, recognize carers' needs and provide more effective support. This study provides the first detailed account of BPD carers' experiences across a broad range of support needs and interactions with community support and health services.

Collaborative Care for Patients With Severe Personality Disorders: Preliminary Results and Active Ingredients From a Pilot Study (Part I).

PURPOSE: To test if a collaborative care program (CCP) with nurses in a coordinating position is beneficial for patients with severe personality disorders. DESIGN AND METHODS: A pilot study with a comparative multiple case study design using mixed methods investigating active ingredients and preliminary results. FINDINGS: Most patients, their informal caregivers, and nurses value (parts of) the CCP positively; preliminary results show a significant decrease in severity of borderline symptoms. PRACTICE IMPLICATIONS: With the CCP, we may expand the supply of available treatments for patients with (severe) personality disorders, but a larger randomized controlled trial is warranted to confirm our preliminary results.