Anne Lise Holm

The emotional pain and distress of borderline personality disorder: A review of the literature

This paper presents a synthesis of content and assessment of the methodological rigour of published literature related to concepts of emotional pain and distress in women with a diagnosis of borderline personality disorder (BPD). In the past two decades, there has been an increase in research about the prevalence of BPD, interventions, and relative effectiveness of various forms of treatment. However, there are few studies regarding emotional pain and distress in women with BPD. Emotional pain has been reported as an adaptive response to repetitive traumatic experiences in childhood. Searches of the EBSCO host, OVID MEDLINE, CINAHL, and PsycINFO databases were carried out using the following search words: borderline personality disorder, emotional pain, distress, self, suffering, women, for the period 1996-2006. Fifteen papers were assessed for methodological rigour, followed by the analysis of the concepts of emotional pain and distress. Three themes emerged from the literature, the emotionally abused and neglected child; struggling with emotions leading to self-injury; and social problems related to difficulties regulating emotions. A high prevalence of reported childhood abuse was revealed. Emotional pain was described as intense for women suffering from BPD. A further synthesis of research findings is recommended to provide information on the effectiveness of interventions.

Chronic care model for the management of depression: Synthesis of barriers to, and facilitators of, success

Depression is a socially- and physically-disabling condition. The Chronic Care Model (CCM) was developed to promote better management of long-term conditions, such as depression, in primary care settings. The aim of the study was to identify barriers to, and facilitators of, success when implementing the CCM for the management of depression in primary care. A systematic search was conducted in electronic databases from January 2005 to December 2011. Thirteen articles met the inclusion criteria and were reviewed by means of a thematic analysis. The barriers were categorized under two themes: lack of organizational, administrative, and professional ability to change and implement the components of the CCM; and lack of clarity pertaining to the responsibility inherent in the role of care manager (often a nurse) when it comes to promoting the patients self-management ability. In terms of the facilitators of success, two themes emerged: leadership support and vision, and redesigning the delivery system. When shaping an environment for organizational change, leadership and professionals must work towards a common goal and vision. Such processes require a care manager with a clear role and responsibilities in order for the health-care system to meet the needs of the person with depression.

Evaluation of self-management interventions for chronic obstructive pulmonary disease.

AIM To evaluate the benefits of self-management interventions on the quality of life of patients with chronic obstructive pulmonary disease. BACKGROUND Chronic obstructive pulmonary disease is one of the most widespread chronic conditions worldwide, and it is predicted to increase over the next decade. Although previous review studies have demonstrated the benefits of self-management interventions on health-care utilisation, their benefits on quality of life are still unclear. METHOD In this systematic review, we examined four randomised controlled trials undertaken between 2000 and 2011 to evaluate the benefits of chronic obstructive pulmonary disease self-management interventions on patient quality of life. RESULTS The main theme that emerged was that self-management interventions improved patient well-being, with three minor themes: reducing the burden on patients, improved patient activity and improved total patient health. CONCLUSION Self-management interventions tend to improve the quality of life of patients with chronic obstructive pulmonary disease. Further randomised controlled trials are recommended to evaluate self-management interventions in chronic obstructive pulmonary disease to confirm these benefits. IMPLICATIONS FOR NURSING MANAGEMENT Nursing management in health services is involved in caring for patients with chronic obstructive pulmonary disease and is responsible for liaising with other members of the health-care team. We recommend that nursing management be engaged in health-care services to develop and implement self-management interventions for chronic obstructive pulmonary disease patients to improve their quality of life.

Older persons' lived experiences of depression and self-management.

Mental ill-health, such as depression in the elderly, is a complex issue that is influenced by the life-world perspective of older persons. Their self-management ability should be strengthened based on an understanding of their situation, perspectives, and vulnerability. The aim of this study was to explore and increase understanding of old persons’ lived experiences of depression and self-management using an interpretative explorative design. Understanding was developed by means of hermeneutic interpretation. One theme, Relationships and Togetherness, and four subthemes, A Sense of Carrying a Shoulder Bag, Walking on Eggshells, Holding the Reins, and Estrangement—a Loss of Togetherness, emerged. A collaborative approach can be important for empowering older persons through self-development and management. Although the findings of the present study cannot be considered conclusive or definitive, they nevertheless contribute new knowledge of older persons’ lived experiences of depression in everyday life.

Reflections on the ethical dilemmas involved in promoting self-management:

Due to their understanding of self-management, healthcare team members responsible for depressed older persons can experience an ethical dilemma. Each team member contributes important knowledge and experience pertaining to the management of depression, which should be reflected in the management plan. The aim of this study was to explore healthcare team members’ reflections on the ethical dilemmas involved in promoting self-management among depressed older persons. A qualitative design was used and data were collected by means of focus group interviews. The results revealed one main theme: ‘Lack of trust in the community health care system’s commitment to bringing about effectiveness and change, based on three themes; ‘Struggling to ensure the reliable transfer of information about depressed older persons to professionals and family members’, ‘Balancing autonomy, care and dignity’ and ‘Differences in the understanding of responsibility’. Lack of engagement on the part of and trust between the various professional categories who work in the community are extremely counterproductive and have serious implications for patient dignity as well as safety. In conclusion, ethical dilemmas occur when staff members are unable to act in accordance with their professional ethical stance and deliver an appropriate standard of care.

The role of the mental health nursing leadership

AIM The aim of the present study was to illuminate what the mental health nursing (MHN) leader needs in order to develop her/his leadership role. BACKGROUND MHN leadership has tended to focus on the nature of the care provided rather than the development of the role. METHOD This literature review (1998-2008) examines papers from the past decade by means of a synthesis of empirical studies. RESULTS Three themes emerged: * clarifying role expectations and areas for development at the same time as increasing the influence on patients with mental health problems; * using evidence-based practice to implement improvements and organizational change in mental health; and * employing communication skills as well as supporting, nurturing and empowering others. CONCLUSION This review provided evidence that the MHN leader needs various skills in order to make enlightened changes that can meet the needs of both patients and staff. IMPLICATIONS FOR NURSING MANAGEMENT The MHN leader needs to explore the range of tasks involved in leadership in order to define role expectations and areas for development. These areas include enhancing patient care; reliance on team work; and attending to the personal life of the staff; increasing collaboration within the organization as well as with the community; utilizing the best available evidence; and communicating in order to improve the organization.holm a.l. & severinsson e. (2010) Journal of Nursing Management18, 463–471 The role of the mental health nursing leadership Aim  The aim of the present study was to illuminate what the mental health nursing (MHN) leader needs in order to develop her/his leadership role. Background  MHN leadership has tended to focus on the nature of the care provided rather than the development of the role. Method  This literature review (1998–2008) examines papers from the past decade by means of a synthesis of empirical studies. Results  Three themes emerged: • clarifying role expectations and areas for development at the same time as increasing the influence on patients with mental health problems; • using evidence-based practice to implement improvements and organizational change in mental health; and • employing communication skills as well as supporting, nurturing and empowering others. Conclusion  This review provided evidence that the MHN leader needs various skills in order to make enlightened changes that can meet the needs of both patients and staff. Implications for nursing management  The MHN leader needs to explore the range of tasks involved in leadership in order to define role expectations and areas for development. These areas include enhancing patient care; reliance on team work; and attending to the personal life of the staff; increasing collaboration within the organization as well as with the community; utilizing the best available evidence; and communicating in order to improve the organization.

A hermeneutic approach to the characteristics of mental health nursing practice

Mental health nursing (MHN) takes a non-reductionist view of the human being, based on a hermeneutic and interdisciplinary perspective. MHN is dependent on the development of hermeneutic knowledge for understanding the deeper meaning of, for example, encountering a patient with emotional pain. The aim of this study was to provide a philosophical discussion about the characteristics of MHN practice. The hermeneutic approach was used to expand the philosophical discussion of MHN. In order to explore the consequences for MHN practice, previous relevant research within the discipline of MHN was used, exemplified by patients suffering from emotional pain. Two themes emerged: A reflective way of being and working and Relationships as a foundation for change and improvements. Four themes emerged related to the practice of the nurse: Desire for confirmation and trust, The vulnerable human being, The difficulties involved in responsibility and The power of self-development, authenticity and freedom. MHN must be open to changing some of the negative images of past interdisciplinary discussions in order to provide high quality care and support to the suffering patient. The hermeneutic approach is one way to help nurses who work in the context of mental health to understand and use their intuition and empathy to empower patients, thus providing hope and future possibilities.

Longing for Reconciliation: A Challenge for Women with Borderline Personality Disorder

The aim of this study was to explore the way in which traumatic childhood experiences influenced the daily life of women with Borderline Personality Disorder (BPD). An explorative design comprising in-depth interviews and a qualitative content analysis was used. The findings revealed one main theme—Longing for Reconciliation—comprising two themes: (1) Living with a sense of shame and guilt and (2) Struggling to be released from a sense of being trapped. Longing for reconciliation influenced the womens daily life as well as their search for the meaning of traumatic childhood experiences. New meaning can emerge through change, forgiveness, and reconciliation, thus helping women with BPD overcome their struggle and gain the insight and strength to look into their secret knowledge. Meaning can emerge and help them to develop an empathic understanding of themselves in the context of past and present relationships.

Desire to survive emotional pain related to self-harm: A Norwegian hermeneutic study

The aim of this study was to explore and interpret womens desire to survive emotional pain related to self-harm. Women who suffer from borderline personality disorder describe emotional pain as intense. Previous research indicates that self-harm is a way of obtaining emotional relief and offers an escape from unwanted emotions, thoughts, and/or distressing situations. An explorative, interpretative design was employed. The data were collected by means of in-depth interviews with a sample of women resident in Norway suffering from borderline personality disorder and were analyzed using a hermeneutic approach. The findings revealed one main theme, self-sacrifice, and two other themes, self-harm (a struggle to be relieved of responsibility) and a fear of intimacy versus intrusion. This study indicates that self-sacrifice appears to imply a longing for reconnection with the self and others. To preserve their self-image, the women require courage to survive the painful state of unworthiness.

Older Persons' Experiences of Depressive Ill-Health and Family Support

The aim of this study was to explore experiences of the meaning of family support among older persons with depressive ill-health. Data were collected from twenty-nine participants through semistructured interviews and analysed using interpretative hermeneutic and reflective methodology. The findings revealed a main theme, hovering between feelings of belongingness and aloneness in relationships with family members, based on two themes: a sense of being worthy and a sense of being unworthy. Experiences of support and lack of support from family members were not opposites but connected in internal relationships and can be pictured as a movement on a continuum of ambiguity. Family support promotes the emotional needs of older persons with depressive ill-health to be confirmed. The family plays a vital role, not always by direct assistance, but indirectly by supporting the older persons own “guiding principles” for managing her/his situation. The feelings of aloneness as well as shame and guilt at poor or absent family responsiveness should be adequately addressed. Innovative nursing care can lead to improvement by focusing on acquiescence to the older persons life situation.