Archives
Attitudes of Registered Psychiatric Nurses Towards Patients Diagnosed with Borderline Personality Disorder
Cecil Deans
Associate Professor of Clinical Nursing, University of Ballarat; Ballarat Health Services, Ballarat VIC
Elizabeth Meocevic
Psychiatric Nurse, North West Health Care Network, VIC
Abstract
Caring for patients with a diagnosis of Borderline Personality Disorder (BPD) has been identified as a problem area for mental health professionals with some studies suggesting that a diagnosis of BPD will influence the level and quality of interaction staff have with patients. It is inherent to psychiatric nursing that practitioners are able to establish rapport, develop trust and demonstrate empathy with consumers of mental health services. Despite the importance of this issue for psychiatric nurses and for consumers, the perceptions and attitudes of psychiatric nurses towards patients diagnosed with BPD have received almost no research attention.
This paper describes findings from a study of attitudes held by 65 registered nurses employed in a psychiatric inpatient unit and psychiatric community service where individuals with a DSM-IV diagnosis of BPD received treatment. In particular, findings relating to Clinical Description, Emotional Reactions, Concerns and Management of patients with BPD are reported.
Results show that a proportion of psychiatric nurses experience negative emotional reactions and attitudes toward people with BPD with the majority of nurses perceiving people with BPD as manipulative, almost one third reporting that patients with BPD made them angry and over one third either 'strongly disagreed' or 'disagreed' that they know how to care for people with BPD. Although psychiatric nurses face many challenges in providing care for patients with BPD, it is also of concern to the profession that one of the problems confronting people with BPD is the negative attitudes of those staff that care for them. Further research is necessary to identify appropriate service frameworks and clinical interventions that assist in more effective clinical management of clients of BPD.
Keywords
attitudes, psychiatric nurses, borderline personality disorder
References
American Psychiatric Association (1995) Diagnostic and statistical manual of mental disorders, 4th edn. Washington DC: American Psychiatric Association, A (1972).
Atkinson RL, Atkinson RC, Smith EE, Bem DJ and Nolen-Hoeksema S (1996) Hilgard's Introduction to Psychology. Harcourt Brace College Publishers, Fort Worth.
Brown LJ (1980) Staff counter transference reactions in the hospital treatment of borderline patients. Psychiatry 43: 333-345.
Burns N and Grove S (1995) Understanding nursing research. Sydney: WB Saunders Company.
Cleary M, Siegfield N and Walter G (2002) Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder. International Journal of Mental Health Nursing 11: 186-191.
Dawson DF (1988) Treatment of the borderline patient: Relationship management. Canadian Journal of Psychiatry 33(5): 370-374.
Fraser K and Gallop R (1993) Nurses' confirming/Disconfirming responses to patients diagnosed with borderline personality disorder. Archives of Psychiatric Nursing II(6) (December): 336-341.
Gallop R (1992) Self destructive behavior in the patient with a borderline personality disorder: Rethinking hospital treatment and management. Archives of Psychiatric Nursing IV(3) (June):178-182.
Gallop R (1995) The patient is splitting: Everybody knows and nothing changes. Journal of Psychosocial and Mental Health Services 23: 6-10.
Gallop R, Lancee W J and Garfunkel P (1989) How nursing staff respond to the label 'borderline personality disorder'. Hospital and Community Psychiatry 40(8): 815-819.
Hugo M (2001) Mental Health Professionals attitudes towards people who have experienced a mental health disorder. Journal of Psychiatric and Mental Health Nursing 8: 419-425.
Kaplan CA (1986) The challenge of working with patients diagnosed as having a borderline personality disorder. Nursing Clinics of North America 21(3) September: 429-438.
Lewis G and Appelby L (1998) Personality Disorder: the patients psychiatrists dislike. British Journal of Psychiatry 153: 44-49.
Little J (1999) Caring in a Different Way. An organisational approach to the Management of people with BPD. Unpublished Manuscript.
Markham D (2003) Attitudes towards patients with a diagnosis of 'borderline personality disorder': Social rejection and dangerousness. Journal of Mental Health 12(6): 595-612.
Markham D and Trower P (2003) The effects of the psychiatric label 'borderline personality disorder' on nursing staff's perceptions and causal attributions for challenging behaviours. British Journal of Clinical Psychology 42: 243-256.
Miller S and Davenport N (1996) Increasing staff knowledge of and improving attitudes towards patients with borderline personality disorder. Psychiatric Services 47(5): 533-535.
O'Brien L (1998) Inpatient nursing care of patients with borderline personality disorder: A review of the literature. Australian and New Zealand Journal of Mental Health Nursing 7: 172-183.
O'Brien L and Flote J (1997) Providing nursing care for a patient with borderline personality disorder on an acute inpatient unit: A phenomenological study. Australian and New Zealand Journal of Mental Health Nursing 6: 137-147.
Piccinino S (1990) The nursing care challenge: Borderline patients. Journal of Psychosocial Nursing 28(4): 22-27.
Polit DF and Hungler BR (1997) Essentials of nursing research: Methods, appraisals and utilization. New York: Lippincott-Raven Publishers.
Sears DO, Peplau LA and Taylor SE (1998) Social Psychology 7th edn. Prentice Hall, NJ, USA.
Stein-Parbury J (2005) Patient & Person. Churchill Livingstone. Sydney.
Stuart SW and Sundeen SJ (1995) Principles and practice of psychiatric nursing. 5th edn. Mosby: Sydney.
World Psychiatric Association (2001) The WPA Clobal Programme to reduce the Stigma and Discrimination because of Schizophrenia-An Interim Report. WPA, Geneva.
eContent Home