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.

‘All the places we were not supposed to go’: a case study of formative class and gender habitus in adventure climbing

This paper explores the origins of meaning in adventurous activities. Specifically, the paper reports on a study of 10 adventure climbers in the Scottish mountaineering community. The study explores how formative experiences have influenced engagement in adventure climbing. Work has been done on the phenomenology of adventure and how individuals interpret and find meaning in the activity—this paper goes a step further and asks where do these dispositions come from? Using Bourdieu’s ideas of field, habitus and forms of capital to frame these experiences in the wider social environment, early experiences are identified that, for the subjects of this study, provide a framework for their later adoption of the ‘adventure habitus’. Among these influences are mainstream education, adventure education in particular, as well as broader formative experiences relating to factors such as gender and class. In addition, the study suggests that accounts differ between males and females in terms of their attitudes and dispositions towards adventure. This may relate to their respective experiences as well as expanding opportunities for both males and females. However, while the ‘adventure field’ provides a context where women can develop transformative identities, these are nearly always subject to male validation.