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

Dickens, Geoffrey L.; Lamont, Emma; Gray, Sarah

doi:10.1111/jocn.13202

Cited by 42 publications

(48 citation statements)

References 71 publications

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“…Borderline personality disorder (BPD) is a mental illness characterized by pervasive patterns of instability of interpersonal relationships and difficulty with impulse control and emotional regulation (American Psychiatric Association 2013; Dickens et al 2016). Persistent suicidality and recurrent thoughts and acts of self-harm are common for persons with BPD (Oumaya et al 2008).…”

Section: Introductionmentioning

confidence: 99%

Why go to the emergency department? Perspectives from persons with borderline personality disorder

Vandyk

Bentz

Bissonette

et al. 2019

Int J Mental Health Nurs

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Through this qualitative study, we explored frequent emergency department use by persons with borderline personality disorder from their perspective. Interpretive description guided the study design, and data were collected through interviews with six individuals diagnosed with borderline personality disorder who had at least 12 emergency department visits for reasons related to their mental illness within a 1‐year timeframe. Using thematic data analysis, we articulate the participants’ experiences through two broad themes: cyclic nature of emergency department use and coping skills and strategies. Unstable community management that leads to self‐ or crisis presentation to the emergency department often perpetuated emergency department use by our participants and the ensuing interventions aimed at acute stabilization. The participants identified a desire for human interaction and feelings of loneliness, failure of community resources (such as crisis lines or therapy), and safety concerns following suicidal ideation, self‐harm, or substance use as the main drivers for their emergency department visits. Our participants identified several potential strategies to protect them against unnecessary emergency department use and improve their health care overall. More work is needed to explore the viability and effectiveness of these suggestions.

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Section: Introductionmentioning

confidence: 99%

Why go to the emergency department? Perspectives from persons with borderline personality disorder

Vandyk

Bentz

Bissonette

et al. 2019

Int J Mental Health Nurs

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“…As a group, people with a BPD diagnosis are unpopular among mental health practitioners (Cleary, Siegfried, & Walter, 2002) who respond to them in ways which could be disconfirming (Fraser & Gallop, 1993), stigmatising (Aviram, Brodsky, & Stanley, 2006) or otherwise qualitatively different from how they respond to others, usually negatively so (Markham & Trower, 2003). A recent integrative, systematic review of the relevant literature (Dickens, Lamont, & Gray, 2016) indicates that, of all practitioners involved in their care, nurses hold the poorest attitudes relative both to other disciplines and to those with non-BPD diagnoses. Even recent studies suggest this is an ongoing problem (Bodner et al, 2015;Kale & Dantu, 2015;Knaak, Szeto, Fitch, Modgill, & Patten, 2015).…”

Section: Introductionmentioning

confidence: 99%

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

Dickens

Lamont

Mullen³

et al. 2019

Journal of Clinical Nursing

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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.

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“…Consequently, any additions to the cultural stock of images of violence associated with mental disorders, such as those found in the study, may contribute to undermining the opportunities people have of establishing and maintaining a robust and personally meaningful social life and managing the challenges that life presents. Further, healthcare workers are not immune to these forces and with the evidence of negative attitudes towards people with a diagnosis of personality disorder both within mental health (Dickens et al., ) and other health services (Hamilton et al., ) these processes may well play out in the quality of healthcare people receive.…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence that some mental health nurses hold prejudicial attitudes towards people with a diagnosis of personality disorder (Dickens et al., ). Raising awareness of the multiple sources that influence nurses’ knowledge and attitude can support greater self‐awareness and improve practice.…”

Section: Discussionmentioning

confidence: 99%

“…People with a diagnosis of personality disorder are considered one of the most stigmatized groups within mental health services (Sheehan, Nieweglowski, & Corrigan, ). This has included negative attitudes from some healthcare workers (Dickens, Lamont, & Gray, ), and reports that some people with this diagnosis have had their distress dismissed (Bonnington & Rose, ) have been treated disrespectfully (Lawn & McMahon, ) and treated as a label rather than an individual (Veysey, ). In the UK, this has meant that despite expansion in the provision of specialist services over the last 15 years (Dale et al., ), and the lack of consistent high quality care has recently prompted a government sponsored consensus statement to improve treatment experiences (Lamb, Sibbald, & Stirzaker, ).…”

Section: Introductionmentioning

confidence: 99%

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Stigma: A linguistic analysis of personality disorder in the UK popular press, 2008–2017

Bowen

2019

Psychiatric Ment Health Nurs

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Accessible Summary What is known on the subject? People with a diagnosis of personality disorder often experience stigma both outside of, and within, mental health services. The media contribute to people's understanding of mental health issues, and negative portrayals appear to lead to increased negative attitudes in readers. Relatively little is known about how the press represent personality disorder, and the types of messages that people with this disorder may be receiving, which may impact on their understanding of themselves and emotional well‐being. What the paper adds to existing knowledge? The key findings indicate that in a 10‐year period, the representation of personality disorder in the popular tabloid press in the UK was characterized by the frequent use of language of violence. The research approach enabled the study to identify significant patterns in the language used, rather than only using a checklist of words that the press are directed to avoid. This adds to our understanding about the images repeatedly presented that may affect how readers treat people with a diagnosis of personality disorder and affect the self‐esteem of those with the diagnosis. What are the implications for practice? Mental health nurses are well placed to address issues of stigma both in terms of the general public's beliefs and the impact it has on those who use mental health services. A greater understanding of the messages in the press can help nurses to support service users who are vulnerable to believing that their lives will start to reflect the negative messages they have read. Abstract IntroductionMany people with a diagnosis of personality disorder experience stigma, and the press’ representations may contribute to those processes. To date, little is known about how the press write about people with personality disorder and analysis of language used is often limited to checklists of words to avoid.AimThe aim of the study was to explore the linguistic characteristics of press articles about personality disorder in popular tabloids in the UK and consider the implications for stigmatization.MethodCorpus linguistics was used to examine a 50% sample of all articles published by the popular press in the UK, from 2008 to 2017, that referred to personality disorder (n = 260).ResultsThe findings identified a range of words that constructed narratives of violence.DiscussionThe method enabled the findings to expand the current level of knowledge in the field, identifying patterns in the use of the language of violence, which may contribute to the processes of self‐stigma.Implications for practiceGreater understanding of the messages in the press can sensitize nurses to common misconceptions about the disorder, how these may have become internalised and the need for psycho‐social interventions to address the impact of self‐stigma on self‐esteem.

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

Abstract: 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.

Cited by 42 publications

References 71 publications

Why go to the emergency department? Perspectives from persons with borderline personality disorder

Why go to the emergency department? Perspectives from persons with borderline personality disorder

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

Stigma: A linguistic analysis of personality disorder in the UK popular press, 2008–2017

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