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.

Liver glucose-6-phosphatase proteins in suckling and weaned grey seal pups: structural similarities to other mammals and relationship to nutrition, insulin signalling and metabolite levels

Phocid seals have been proposed as models for diabetes because they exhibit limited insulin response to glucose, high blood glucose and increasing insulin resistance when fasting. Liver glucose-6-phosphatase (G6Pase) catalyses the final step in glucose production and is central to glucose regulation in other animals. G6Pase comprises a translocase (SLC37A4) and a catalytic subunit (G6PC). G6PC and SLC37A4 expression and activity are normally regulated by nutritional state and glucostatic hormones, particularly insulin, and are elevated in diabetes. We tested the hypotheses that (1) grey seal G6PC and SLC37A4 cDNA and predicted protein sequences differ from other species’ at functional sites, (2) relative G6Pase protein abundances are lower during feeding than fasting and (3) relative G6Pase protein abundances are related to insulin, insulin receptor phosphorylation and key metabolite levels. We show that G6PC and partial SLC37A4 cDNA sequences encode proteins sharing 82–95 % identity with other mammals. Seal G6PC contained no differences in sites responsible for activity, stability or subcellular location. Several substitutions in seal SLC37A4 were predicted to be tolerated with low probability, which could affect glucose production. Suckling pups had higher relative abundance of both subunits than healthy, postweaned fasting pups. Furthermore, relative G6PC abundance was negatively related to glucose levels. These findings contrast markedly with the response of relative hepatic G6Pase abundance to feeding, fasting, insulin, insulin sensitivity and key metabolites in other animals, and highlight the need to understand the regulation of enzymes involved in glucose control in phocids if these animals are to be informative models of diabetes.

A tool to measure progress and outcome in recovery

Recovery and the use of routine outcome measurement tools are key topics for mental health nurses. This article reports on research carried out to assess the usability of an outcome measure designed to assess recovery in clinical practice. Results indicate that the Individual Recovery Outcomes Counter (I.ROC) is both easy to use and well liked by services users.

Vocational training and knowledge development: a deeper understanding

Construction management research literature has identified the importance of understanding the practical realities of skills and training provision and the role of reflective practice in the development of knowledge. This paper examines vocational training of experienced site staff in the development of their knowledge through SVQ training to investigate the primary factors for successful learning in site-based construction staff with a supervisory/management role. Using semi-structured interviews the impact of vocational training on individual candidates and other sitebased staff are investigated. The paper explores, through the reflections of 26 SVQ candidates (20 SVQ3 and 6 SVQ4), a deeper understanding of how site supervisors and site managers learn through the SVQ process and develop tacit knowledge through formal reflection. Reflective practice develops practical wisdom (Phronesis). The investigation explains aspects of practical wisdom and how knowledge, practice and skills are developed through vocational training. There is a clear perception by those completing the qualification that it has enabled them to perform their job better identifying numerous examples relating to problem solving, critical thinking, making decisions and leadership. It has been found that Phronesis is evident on a day-to-day basis on site activities developed through reflective practice in personal development. The reflective practice in developing knowledge also builds, within individuals, a better understanding of themselves and their capabilities through the learning achieved in the SVQ. Future work is identified around analysing the role of the assessor in facilitating Phronesis in the SVQ context.