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.

Performance of protective factors assessment in risk prediction for adults: systematic review and meta-analysis

Protective factors are neglected in risk assessment in adult psychiatric and criminal justice populations. This review investigated the predictive efficacy of selected tools that assess protective factors. Five databases were searched using comprehensive terms for records up to June 2014, resulting in 17 studies (n = 2,198). Results were combined in a multilevel meta-analysis using the R (R Core Team, R: A Language and Environment for Statistical Computing, Vienna, Austria: R Foundation for Statistical Computing, 2015) metafor package (Viechtbauer, Journal of Statistical Software, 2010, 36, 1). Prediction of outcomes was poor relative to a reference category of violent offending, with the exception of prediction of discharge from secure units. There were no significant differences between the predictive efficacy of risk scales, protective scales, and summary judgments. Protective factor assessment may be clinically useful, but more development is required. Claims that use of these tools is therapeutically beneficial require testing.

Care planning for aggression management in a specialist secure mental health service: user involvement

This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation.

Crime and Punishment.

The study of Victorian crime and punishment is a rich area of research that has attracted the interest not only of literary scholars but also of social historians, legal historians, and criminologists. Related scholarship therefore often situates itself at the intersection of traditional disciplinary boundaries, facilitating interdisciplinary conversation. Crime and punishment was a pressing issue for the Victorians and provoked a wealth of responses from contemporaneous commentators in literature, culture, and science. As a new phase of industrialization brought immense wealth for some and abject poverty for others, Victorian urban centers in particular were afflicted by crime. Without an effective system of social welfare in place, social inequality and deprivation drove women, men, and children into petty crime and more serious offenses, resulting in severe punishment ranging from incarceration via penal transportation to hanging. Public executions, not abolished until 1868, attracted huge crowds of spectators, including authors such as Charles Dickens and William Thackeray, who wrote about these experiences. A forerunner of the popular press, street literature conveyed and illustrated these events for a broad audience. Execution broadsides of famous cases, printing the alleged last lamentations of convicts on the scaffold in verse, are estimated to have sold by the million. As the legal system was undergoing reform (comprising changes in legal evidence procedure, divorce law, women’s property rights, and punishment for sexual offenses, for example), sensational trials caused furor and stimulated commentary in literature and the media. Crime and punishment was discussed in a range of literary and popular genres, poetry, and reformist writing. The “Newgate School” of fiction was accused of glamorizing crime, and the popular penny dreadfuls were feared to corrupt public morals. Sensational fiction in the 1860s, which often drew on real-life criminal cases and newspaper reports, depicted the supposedly respectable middle-class family home as a center of transgression. Similarly, detective fiction typically focused on crime in the world of the middle classes. For the student new to the subject of crime and punishment, this area’s interdisciplinary nature can pose an initial challenge.

Experiences of women in secure care who have been prescribed clozapine for borderline personality disorder

Background: Clozapine is an atypical antipsychotic medicine which can cause significant side-effects. It is often prescribed off-license in severe cases of borderline personality disorder contrary to national treatment guidelines. Little is known about the experiences of those who take clozapine for borderline personality disorder. We explored the lived-experience of women in secure inpatient care who were prescribed clozapine for borderline personality disorder. Findings: Adult females (N=20) participated in audio-taped semi-structured interviews. Transcripts were subject to thematic analysis. The central themes related to evaluation, wellbeing, understanding and self-management; for many, their subjective wellbeing on clozapine was preferred to prior levels of functioning and symptomatology, sometimes profoundly so. The negative and potentially adverse effects of clozapine were explained as regrettable but relatively unimportant. Conclusions: When psychological interventions are, at least initially, ineffective then clozapine treatment is likely to be evaluated positively by a group of women with borderline personality disorder in secure care despite the potential disadvantages.

A "Greater Britain": colonial kin in fictions of settlement, 1850-1890

This dissertation traces the ways in which nineteenth-century fictional narratives of white settlement represent “family” as, on the one hand, an abstract theoretical model for a unified and relatively homogenous British settler empire and on the other, a fundamental challenge to ideas about imperial integrity and transnational Anglo-Saxon racial identification. I argue that representations of transoceanic white families in nineteenth-century fictions about Australian settler colonialism negotiate the tension between the bounded domesticity of an insular English nation and the kind of kinship that spans oceans and continents as a result of mass emigration from the British isles to the United States, Canada, New Zealand, and the Australian colonies. As such, these fictions construct productive analogies between the familial metaphors and affective language in the political discourse of “Greater Britain”—-a transoceanic imagined community of British settler colonies and their “mother country” united by race and language—-and ideas of family, gender, and domesticity as they operate within specific bourgeois families. Concerns over the disruption of transoceanic families bear testament to contradictions between the idea of a unified imperial identity (both British and Anglo-Saxon), the proliferation of fractured local identities (such as settlers’ English, Irish Catholic, and Australian nationalisms), and the conspicuous absence of indigenous families from narratives of settlement. I intervene at the intersection of postcolonial literary criticism and gender theory by examining the strategic deployments of heteronormative kinship metaphors and metonymies in the rhetorical consolidation of settler colonial space. Settler colonialism was distinct from the “civilizing” domination of subject peoples in South Asia in that it depended on the rhetorical construction of colonial territory as empty space or as land occupied by nearly extinct “primitive” races. This dissertation argues that political rhetoric, travel narratives, and fiction used the image of white female bourgeois reproductive power and sentimental attachment as a technology for settler colonial success, embodying this technology both in the benevolent figure of the metropolitan “mother country” (the paternalistic female counter to the material realities of patriarchal and violent settler colonial practices) and in fictional juxtapositions of happy white settler fecund families with the solitary self-extinguishing figure of the black aboriginal “savage.” Yet even in the narratives where the continuity and coherence of families across imperial space is questioned—-and “Greater Britain” itself—-domesticity and heteronormative familial relations effectively rewrite settler space as white, Anglo-Saxon and bourgeois, and the sentimentalism of troubled European families masks the presence and genocide of indigenous aboriginal peoples. I analyze a range of novels and political texts, canonical and non-canonical, metropolitan and colonial. My introductory first chapter examines the discourse on a “Greater Britain” in the travel narratives of J.A. Froude, Charles Wentworth Dilke, and Anthony Trollope and in the Oxbridge lectures of Herman Merivale and J.R. Seeley. These writers make arguments for an imperial economy of affect circulating between Britain and the settler colonies that reinforces political connections, and at times surpasses the limits of political possibility by relying on the language of sentiment and feeling to build a transoceanic “Greater British” community. Subsequent chapters show how metropolitan and colonial fiction writers, including Charles Dickens, Anthony Trollope, Marcus Clarke, Henry Kingsley, and Catherine Helen Spence, test the viability of this “Greater British” economy of affect by presenting transoceanic family connections and structures straining under the weight of forces including the vast distances between colonies and the “mother country,” settler violence, and the transportation system.

The Cat Who Walks Through Years: Chris Claremont's X-Men as Kitty Pryde's bildungsroman

This dissertation examines the fictional character Kitty Pryde from the X-Men comic book series during the tenure of writer Chris Claremont. Claremont's work on the character primarily involves the years 1980-1990, though a return to writing the character in the 2000s is also discussed when relevant. The thesis question revolves around the definition of the bildungsroman genre and whether Claremont's narrative arc for Kitty Pryde's character fulfills that definition. Jerome Hamilton Buckley's 1974 book Season of Youth: The Bildungsroman from Dickens to Golding is used as the primary authority for the bildungsroman genre, and more specifically a list of nine criteria that Buckley deems particularly key to the definition of the genre. Each of the nine criteria is looked at in depth, demonstrating where and how they can be found in the narrative, if at all. However, because Buckley's perspective and criteria come from a time of less diversity, examination from a feminist and minority perspective is also added with ideas from Rita Felski and Stella Bolaki. Combining Buckley's initial list of nine criteria with more modern criticism, these ideas are then used to analyze Kitty Pryde's narrative arc and to determine whether it can be seen as a bildungsroman. The findings support reading Claremont's narrative arc of the Kitty Pryde character as a bildungsroman. Three of Buckley's nine key themes are identified as particularly prevalent in the narrative: the search for a vocation, ordeal by love, and the conflict of generations. Three more key themes are found to be less prevalent but still clearly present: the search for a working philosophy, the larger society, and alienation. Because Buckley's definition for the bildungsroman genre requires the presence of six of his nine key themes, the presence of the aforementioned six thus validate the reading of the narrative as a bildungsroman. The text also provides some suggestions for finding the three least applicable key themes within the narrative, but because their presence is not necessary to fulfill the definition of the bildungsroman, they are not rigorously examined. In addition to fulfilling Buckley's key themes, the paper also discusses the more modern minority-oriented views. It is shown how the narrative can be read in terms of a journey to diverge from norms, as per Felski's ideas of the unique qualities of the specifically female bildungsroman. As Kitty Pryde's narrative can be shown to conform to the bildungsroman ideas of both Buckley and Felski, the thesis question is thus answered positively: Chris Claremont's X-Men can indeed be read as Kitty Pryde's bildungsroman.

Structured professional judgement approach to risk assessment: generalisability across patient groups for the prediction of adverse outcomes in secure mental health care

This is a redacted version of the the final thesis. Copyright material has been removed to comply with UK Copyright Law.

El videojuego League of legends y su efecto en memoria de trabajo visual y solución de problemas

El propósito de este estudio es medir los efectos que tiene el videojuego League of Legends en los procesos cognitivos de memoria de trabajo visual (MVT) y solución de problemas (SP). Para medir dichos efectos se implementó un diseño pre test-post con un grupo experimental y uno control, compuestos cada uno por siete participantes, en donde se evaluaron los procesos previamente mencionados utilizando los cubos de Corsi para MVT y las matrices del WAIS III para SP. Después de realizar los respectivos entrenamientos se encontraron resultados significativos en los diferentes momentos de aplicación. En el grupo experimental se encontraron diferencias en la variable dependiente SP, mientras que en el grupo control en MVT, pero no en la interacción entre grupos ni diferencias entre grupos, lo que sugiere un efecto de familiarización a la prueba.