Nadine Nehls

Borderline personality disorder : The voice of patients

The purpose of this interpretive phenomenological study was to generate knowledge about the experience of living with the diagnosis of borderline personality disorder. Persons identified as meeting DSM-III-R (American Psychiatric Association, 1987) or DSM-IV (American Psychiatric Association, 1994) criteria for borderline personality disorder were invited to participate in a private interview focusing on what it means to live with the diagnosis. The data were analyzed using the procedures of interpretive phenomenological data analysis (Benner, 1994; Diekelmann, Allen, & Tanner, 1989). Three themes were identified: (a) living with a label, (b) living with self-destructive behavior perceived as manipulation, and (c) living with limited access to care. The findings suggest that mental health care for persons with borderline personality disorder could be improved by confronting prejudice, understanding self-harm, and safeguarding opportunities for dialogue.

BORDERLINE PERSONALITY DISORDER: GENDER STEREOTYPES, STIGMA, AND LIMITED SYSTEM OF CARE

In North America, there may be no other psychiatric diagnosis more laden with stereotypes and stigma than borderline personality disorder. People who live with this label--the majority being female--are often marginalized or denied access to mental health services. In this article, the author reviews the theoretical underpinnings of the diagnosis, as well as the stigmatizing practices and limited services for seriously ill persons with borderline personality disorder diagnoses. In light of this review, new directions for mental health practice, education, and research are proposed.

Brief Hospital Treatment Plans: Innovations in Practice and Research

Hospital care for persons with mental health problems has changed dramatically in the past two decades. The emphasis on community-based models of care, cost containment, and the concern that psychiatric hospitalization may be ineffective or even harmful for some clients has led to the development of innovative hospital treatment programs. In this paper, the author examines a brief hospital treatment program developed for persons who have been identified, either previously or currently, with borderline personality disorder. The typical features of brief hospital plans, the lived experiences of five participants, and the changes in hospital utilization before and after the involvement in the program are discussed. The findings reveal the benefits as well as the limitations of this innovative program in improving the day-to-day lives of people with mental health problems. The methodology and results of this study provide direction for innovation and diversification in psychiatric nursing practice and research.

Brief Hospital Treatment Plans for Persons With Borderline Personality Disorder: Perspectives of Inpatient Psychiatric Nurses and Community Mental Health Center Clinicians

Despite growing recognition of the challenges inherent in helping persons with borderline personality disorder, systematic investigation of caring for this population in specific treatment situations is lacking. In this study, an innovative hospital treatment program for persons with borderline personality disorder was evaluated. Using an interpretive phenomenological approach, a team of researchers analyzed data from in-depth, individual interviews with inpatient psychiatric nurses and community mental health center clinicians (n = 13) and thereby identified a constitutive pattern, the paradoxes of helping. At a time when innovation in caring for persons with this disorder is sought, an examination of these paradoxes will help identify those practices to be abandoned, those to be extended, and those to be preserved.

Being a case manager for persons with borderline personality disorder: Perspectives of community mental health center clinicians

The scope of case management has expanded to include persons with chronic, nonpsychotic disorders, in particular, persons diagnosed with borderline personality disorder. Despite more widespread use, literature about case management for persons with this disorder is limited. To address this gap in knowledge, a study of the day-to-day experiences of case managers who care for persons with borderline personality disorder was conducted. Seventeen community mental health center case managers gave their informed consent to participate in individual, in-depth interviews. The interviews were analyzed using an interpretive phenomenological research approach. The analysis showed a pattern of monitoring self-involvement. The case managers monitored themselves in terms of expressing concern and setting boundaries. These shared practices highlight a central and unique component of being a case manager for persons with borderline personality disorder, that is, the case managers focus of attention is on self. By focusing on the self, case managers seek to retain control of the nature of the relationship. The author asserts that the matter to be resolved is not to determine whether retaining or relinquishing control is better, but rather, how best to help practitioners maintain a helpful relationship over time with persons who have borderline personality disorder. In an effort to accomplish this goal, questions about current helping practices and suggestions for working collaboratively with persons who have this diagnosis are provided.

Developing a systems approach to caring for persons with borderline personality disorder

Most community mental health centers have not established a treatment approach for seriously ill persons with borderline personality disorder that is multi-focused, coordinated, comprehensive, and continuous. The authors propose that the systems approach to caring for persons with schizophrenia (Stein, Diamond, & Factor, 1990) be modified and tested for its efficacy in helping seriously ill persons with borderline personality disorder. The rationale for proposing this model of care and its underlying principles and clinical components is described in this paper.

Borderline personality disorder and group therapy

This study examined the process and outcome of group therapy for community health center clients with borderline personality disorder. The results indicated that group members rated Yaloms curative factors to be increasingly helpful over time, and that universality and existential factors were consistently ranked as very helpful group process variables. The group sessions also were associated with positive outcomes, as evidenced by significant improvement in Goal Attainment Scale scores and the depression and hostility scales of the Brief Symptom Inventory. The results of this study suggest that group therapy is a valued and effective treatment option for people with borderline personality disorder.

What is a Case Manager? The Perspective of Persons with Borderline Personality Disorder

BACKGROUND: Case management services have expanded to include persons with diagnoses other than schizophrenia. Attention has been directed toward persons with chronic, nonpsychotic disorders—in particular, persons with personality disorders. However, to date, the nature and effects of case management for persons with personality disorders are relatively unknown. OBJECTIVES: The purpose of this study was to explore case management services from the perspective of community mental health center clients with borderline personality disorder. By providing descriptions and interpretations of the day-to-day experience of having a case manager, the benefits and limitations of this service delivery model for persons with borderline personality disorder are revealed. STUDY DESIGN: An interpretive, phenomenological research approach was used. RESULTS: Based on the interview data, the following three themes were identified and explicated through the words of the clients: (1) “My case manager treats me like a person,” (2) “My case manager is more than a case manager,” and (3) “My case manager has stuck with me for years.” CONCLUSIONS: The results suggest that person-centered, comprehensive, and continuous services from a single caregiver are the core of case management services for persons with borderline personality disorder. Participants perceived their case managers as respectful, resourceful, and reliable. Further work is needed to determine how these practices can be more widely disseminated in mental health care for persons with borderline personality disorder.

Pathways to the PhD in Nursing: An Analysis of Similarities and Differences

New educational pathways are needed to increase the number of doctor of philosophy (PhD)-prepared nurses. To address this need, an early-entry PhD option designed to engage students in PhD coursework and research during the undergraduate nursing major was developed at the University of Wisconsin-Madison. An evaluation comparing the early-entry option with two more conventional entry points was conducted. Three groups (N = 84) comprised the sample: (a) early-entry students admitted as undergraduates or immediately upon graduation (N = 29), (b) mid-entry students with baccalaureate degrees and at least 1 year of work experience (N = 27), and (c) delayed-entry students with masters degrees and 1 or more years of work experience (N = 28). Qualitative and quantitative data were collected from the 3 groups of students who were admitted from 2002 to 2011. The sources of data were transcriptions of individual interviews and reviews of existing data. Seventy-seven percent of the sample participated in the individual interviews. The database review included all students who matriculated into the PhD program. Common themes among the 3 groups included a need for educational funding, the importance of a faculty mentor, and concern about preparation for the teaching role and the academic work environment. The groups were also comparable in terms of research productivity during doctoral study and postgraduation employment. Differences were found on measures of diversity, program progression, and perceptions of clinical competence. The findings provide needed data for the development and expansion of educational pathways to the PhD in nursing.

Early entry to a doctoral degree in nursing program: analysis of student experiences.

Educational innovations that encourage younger students to pursue doctoral research training are timely and important. To this end, an evaluation of an early-entry doctoral (PhD) program in nursing was conducted. One component of this evaluation examines qualitative data from students admitted to the PhD program as undergraduates or immediately upon graduation from the undergraduate program. The evaluation included all students (N = 29) admitted over a 10-year period, from 2002 to 2011. Eighty-three percent of this population agreed to participate. Transcriptions of individual interviews were analyzed using a qualitative descriptive method. The results are categorized into three general areas: decision making about becoming a nurse and a PhD student, facilitators of admission to and progression in an early-entry PhD program, and the challenges of being an early-entry PhD student. The findings provide the data necessary to guide revisions of existing programs and stimulate the development of new early-entry PhD programs.