A Borderline Personality Disorder Nursing Essay.
A Borderline Personality Disorder Nursing Essay. This chapter examines the specific
characteristics of borderline personality disorder. I will look at how BPD is understood by
staff, the behaviours associated with BPD and how education can be advantageous in
changing staff's understanding of BPD.A Borderline Personality Disorder Nursing
Essay.ORDER A PLAGIARISM-FREE PAPER HERECleary et al (2002) explored the
experiences, knowledge and attitudes of staff with the aim of assessing future training
needs. They looked at staff's understanding of BPD and indicated that it is a complicated
disorder with complicated treatment issues. The study also acknowledges that the nature of
the disorder can have a major impact on services and the potential to polarise staff.A
Borderline Personality Disorder Nursing Essay.This study had a poor response rate which
may pose questions surrounding its generalisability to other areas. However, it indicates
that 67% of staff consider themselves knowledgeable in the management of BPD despite
76% of staff expressing that more workshop training would be advantageous with 74%
discussing the need for "regular education…to aid in the management of patients with
BPD" (Cleary 2002:189). Overall 95% of staff expressed a willingness to dedicate up to two
hours a month towards education should their health authority provide it. This is reflected
in similar studies that also consider education that improves staff understanding BPD can
lead to better treatment and treatment planning (Krawitz 2004) therefore producing "the
best possible care for their clients" (Cleary et al 2002:190).A Borderline Personality
Disorder Nursing Essay.In their study, Woollaston & Hixenbaugh (2008) noted that the
negativity staff feel, such as guilt, anger and hopelessness when interacting with BPD
patients can be attributed to the overuse of defence mechanisms such as team-splitting and
projection. These behaviours can impact on the nurse's cognitions, thus negatively affecting
their behaviour.An important implication of this study is the need for services to both
recognise and provide training to nursing staff (Woollaston & Hixenbaugh 2008). The study
advocates education using a cognitive-behavioural approach to provide staff with a
framework in which to understand BPD behaviour, nurses' reaction to this and how
negative interactions have an impact on the patients affect, and behaviour (Woollaston &
Hixenbaugh 2008). However as the researcher had previously worked with the participants,
thus possibly affecting their inclination to express themselves freely, the validity of the
results are questionable.A Borderline Personality Disorder Nursing Essay.In a similar study
self-harming, staff-splitting and manipulative behaviours were cited as being both complex
and challenging (McGrath & Dowling 2012). Participants associated BPD patients as having

some form of 'hidden agenda', describing BPD behaviours as "superficial and calculated in
order to get their needs met" (McGrath & Dowling 2012:5). However BPD patients report
living with a pejorative label, where self-destructive behaviours, such as self-harm, are
perceived as manipulative as opposed to a release of inner tension. Whether the study has
good generalisability is however questionable due to only one ward being used within the
study.The study advises brief training workshops in helping nursing staff develop the skills
needed to carry out treatment plans (McGrath & Dowling 2012), thus improving positivity
when working with BPD. Appropriate training would provide a better understanding of the
complexity of BPD and educate nursing staff about "realistic expectations of treatment
outcomes to counter later pessimism" (McGrath & Dowling 2012:8). This would allow for
the modification of negative nursing responses towards a more therapeutic level and
alleviate negative interpersonal working experiences (McGrath & Dowling 2012) for both
staff and patients.A Borderline Personality Disorder Nursing Essay.Commons-Treloar
(2009) supports this view in her research on the effectiveness of education on attitudinal
changes towards BPD. She discusses staff views of behavioural disturbance within BPD as
having some level of consciousness in the use of self-harm to relieve distress. As such,
repeated presentations of self-harming behaviour do not tend to generate compassionate
responses "with many evaluating the behaviour as manipulative" (Commons-Treloar
2009:1131). Although a validated questionnaire was used in this study, it only allowed for
positive or negative answers. Having no neutral response may apply some restrictions to
the results.Education was used to help staff recognise that the need to self-harm was not
due to an immediate environmental stressor but lay in some past trauma event, therefore
the result of an unconscious sense of guilt (Commons-Treloar 2009). This suggests BPD
patients who unconsciously engage in self-harm display a reduced responsibility for their
behaviours (Commons-Treloar 2009). Education here provided a greater empathetic
response from staff and helped to improve the interpersonal relationship.A Borderline
Personality Disorder Nursing Essay.Working with personality disordered (PD) inmates who
display negative behaviours is cited the main stressor for prison officers (Bowers et al
2005). Due to prisoners coming into contact with the healthcare system via sections 47 and
48 of the Mental Health Act (GB 2007) and nursing staff working closely with prison
officers, this study is valid in providing a comparative view of other staff disciplines'
working with BPD. However, the semi-structured interviews reflected on the previous eight
month period which may have introduced some recall bias into the study.Behaviours such
as self-harm, consistent complaints, manipulation and "attention-seeking" (Bowers et al
2005:177) are noted to be the most prominent behaviours that elicited negative responses
from staff. These characteristics were associated with staff feeling less confident and having
a lower tolerance for working with prisoners with a diagnosis of BPD.A Borderline
Personality Disorder Nursing Essay.Education in knowledge, skills and understanding
surrounding PD is cited as having a positive impact (Bowers et al 2005:178). The study
shows that getting to know the prisoners' past lived experiences and education on aetiology
helped staff to understand the behaviours. This provided staff with the ability to use new
educational knowledge to help them interact with prisoners more productively by
increasing their tolerance of negative behaviours (Bowers et al 2005). The results for this

study are comparative to studies undertaken in mental health units and show a clear
correlation between the understanding of BPD within both mental health and custody
institutions.A Borderline Personality Disorder Nursing Essay.Due to the inappropriate and
intense anger that BPD patient have difficulty managing (Bland et al 2007), verbal abuse
and threatening language is commonly experienced by staff. This had led staff into
perceiving BPD patients as powerful and dangerous, "an unstoppable force that leaves a
trail of destruction" (Westwood & Baker 2010:660). In these cases education can help staff
understand how their own frustrations and anger can lead to unprofessional responses,
which Woollaston & Hixenbaugh (2008) explain serve to reinforce the patient's negative
beliefs about themselves, therefore increasing the negative behaviours displayed.A
Borderline Personality Disorder Nursing Essay.Training and supervision have been
reported by many studies as being a vital aid to helping staff to navigate these
transference/counter-transference behavioural issues (James & Cowman 2007, Commons-
Treloar 2009, Woollaston & Hixenbaugh 2008, McGrath & Dowling 2012) where staff can
discuss openly their concerns, gain an understanding of the origins of BPD behaviours and
learn better ways to manage (Bowers et al 2005).A Borderline Personality Disorder Nursing
Essay.3.2 CHAPTER TWO. Staff attitudes; education challenging the cycle of rejection.In this
chapter I will examine the specific attitudes displayed by staff working with borderline
personality disorder (BPD). I will look at both negative and positive attitudes, how these
attitudes can either promote or deny fair access to services and how education can be
beneficial in changing staffs attitudes towards BPD.Attitude is constructed from past
experience, feelings, behavioural responses and knowledge on a particular… [subject
or]…object. Holding a particular attitude will increase the probability that a person
will act in a certain way.Commons-Treloar & Lewis 2008b: 982.The tendency of people with
BPD to reject therapeutic care and engage in behaviours that are difficult to manage can
leave staff feeling unhappy, frustrated and negative (Cleary et al 2002). All staff working
with BPD patients are vulnerable to these negative emotions, which in turn can lead to
derogatory terms and negative attitudes being attached to the patient (Krawitz 2004,
McGrath & Dowling 2012).A Borderline Personality Disorder Nursing Essay.In their study,
Bowers & Allen (2006) make a clear connection between staff attitudes, staff morale and
emotional self-management. Their study discusses the negative influence on attitude being
a lack of knowledge in working with personality disorder (PD) causing difficulty in staff
managing their own responses to the patient. One of the largest influences in changing
negative and derogatory attitudes into positivity is cited as being the introduction of
targeted education on PD and related issues, producing "a more purposeful and optimistic
outlook" (Bowers & Allen 2006:288) amongst staff.A Borderline Personality Disorder
Nursing Essay.Studies suggest that health professionals often avoid having contact with
patients with a diagnosis of BPD (Commons-Treloar & Lewis 2008a,b, McGrath & Dowling
2012) and fail to enter in any meaningful dialogue surrounding reasons for negative
behaviours. Many staff report that they would only provide the minimum level of care, at
the end of the shift, unless completely necessary (McGrath & Dowling 2012), therefore
demonstrating a higher level of social rejection towards patients with BPD than other
mental health illnesses (Cleary et al 2002, James & Cowman 2007, McGrath & Dowling

2012). However the study also suggests that improved education on BPD can help staff to
respond to negative patient behaviours "consistently without anger, frustration and fear"
(McGrath & Dowling 2012:8) therefore providing more positive therapeutic input. However,
poor representation of unqualified staff within the study disregards a large portion of the
workforce and introduces some questions around the generalisability of theses results to all
staff grades.A Borderline Personality Disorder Nursing Essay.Some studies discuss the
differences in attitudes between male and female staff. Female staff have been shown to
have more positive attitudes towards BPD (Bowers & Allan 2006, Commons-Treloar &
Lewis 2008a,b) and show more optimism and enjoyment when working with BPD patients
(Bowers & Allan 2006) than male staff. This is hypothesised as being due to "the traditional
sex role of the female being able to nurture patients with significant emotional difficulties"
(Commons-Treloar & Lewis 2008a:582).A Borderline Personality Disorder Nursing Essay.It
is suggested that along with the standard biopsychosocial factors being taught, different
educational approaches may be needed to help improve male attitudes such as the
provision of case vignettes using male BPD patients as opposed to female (Commons-
Treloar & Lewis 2008a,b).Studies comparing mental health nurses and emergency medical
nurses' attitudes toward BPD and self-harm (Commons-Treloar & Lewis 2008a,b)
demonstrate that 75% of staff reported that BPD behaviours, such as self-harming, are
difficult to manage and 65% of staff found it difficult to build up a therapeutic relationship.
They also report emergency medical nurses' frustrations at being unable to 'cure' the
patient and feeling care is ineffectual in the context of repeated presentations with similar
injuries (Commons-Treloar & Lewis 2008a,b). These negative attitudes surrounding the
disorder, cause distress and inner conflict, therefore leading to an absence of empathy.
However, both studies show a non-representation of unqualified staff which disregards a
large portion of the workforce and affects generalisability to the entire workforce.A
Borderline Personality Disorder Nursing Essay.Mental health workers showed higher levels
of positivity towards working with BPD patients than emergency medical nurses' mainly
due to the increased level of educational knowledge surrounding the disorder (Commons-
Treloar & Lewis 2008b). This demonstrates that providing education surrounding the
aetiology and prevalence of BPD to nurses, in all clinical areas, helps staff to respond in a
more therapeutic manner without feelings of futility and frustration (Cleary et al 2002,
Krawitz 2004, Commons-Treloar & Lewis 2008a,b, McGrath & Dowling 2012).Nurses have
been described as perceiving BPD patients as "a destructive whirlwind" (Woollaston &
Hixenbaugh 2008:703). Nurses perceive patients as a powerful, dangerous and unrelenting
force, which leaves an aftermath of destruction. They found BPD patients to be hugely
disruptive, demanding and draining of both staff and resources (Woollaston & Hixenbaugh
2008, Maltman & Hamilton 2011). These feelings of being disheartened and frustrated have
been quoted as one of the main reasons staff perceive BPD patients in a negative light and
lead to the perception of them being "untreatable and undeserving of care" (Woollaston &
Hixenbaugh 2008:708).A Borderline Personality Disorder Nursing Essay.Interestingly, this
paper also suggest that some staff do consider BPD patients as deserving of care and display
a sense of optimism surrounding the treatment of BPD. This supports the notion that staff
can project positive attitudes towards BPD patients as well as negative (Bowers & Allan

2006, Commons-Treloar & Lewis 2008a,b, Maltman & Hamilton 2011). Positive attitudes
were noted to be predominantly present in newly qualified staff which could lead to the
hypothesis that undergraduate training on BPD is an effective tool in building positive
attitudes. However, further targeted training by specific services would help to enhance
clinical skills and would improve the nurse's confidence in working with BPD (Cleary 2002,
Woollaston & Hixenbaugh 2008).This view is endorsed by James & Cowman (2007) who
demonstrated that the majority of staff reflected reasonably positive attitudes towards
patients with BPD, a view which tends to be inconsistent with other studies within this area
(Purves & Sands 2008, McGrath & Dowling 2012). This study suggests that "given the
evidence of the positive benefits of training on knowledge and attitude" (James & Cowman
2007:647), the lack of education on BPD needs to be addressed especially as it helps to
maintain an enthusiastic, positive workforce that is confident in its abilities (James &
Cowman 2007) in managing BPD patient's safely.A Borderline Personality Disorder Nursing
Essay.Studies on staff attitudes within prison settings displayed similar results to that of
nursing environments, with staff displaying both positive and negative attitudes towards
prisoners with personality disorder (PD) (Bowers et al 2005, Maltman & Hamilton 2011).
Interestingly, where Bowers et al (2005) found approximately equal numbers of positive
and negative attitudes with moderate improvements in attitude following targeted clinical
education, Maltman & Hamilton (2011) found that, although attitudes were relatively equal,
there was only a small increase in post-educational attitudes towards BPD.A Borderline
Personality Disorder Nursing Essay.However, both studies (Bowers et al 2005, Maltman &
Hamilton 2011) showed that education on PD provided a better knowledge base, which in
turn helped officers to interact more productively with patients and increased the tolerance
of negative behaviours. Education for this staff group provided an increased awareness of
the prisoners as victims themselves, therefore allowing staff to connect the prisoner's
current behaviours to childhood invalidation resulting from childhood abuse. This led on to
staff seeing the prisoner as individuals, requiring care tailored to their needs (Bowers et al
2005). As a result the study showed that staff displayed a more positive attitude when
interacting with prisoners.A Borderline Personality Disorder Nursing Essay.Maltman &
Hamilton (2011) also found significant improvements in staff's feelings of vulnerability.
Officers reported feeling "less fearful, anxious, manipulated… outmanoeuvred and
exploited" after educational input (Maltman & Hamilton 2011:252). These changes were
still present at the studies two month follow-up and correspond to Bowers et al (2006)
findings on the influence of education on changing staff attitude.A Borderline Personality
Disorder Nursing Essay.3.3 CHAPTER THREE. Education; breaking the cycle of
negativity.The aim of this chapter is to look at targeted clinical education and provide the
reader with an overview of available training and it's efficacy in instilling positive
attitudinal change. I will discuss the types of training that have been shown to be most
effective in challenging and changing staff negativity into positive and proactive person-
centred care for people with a Borderline Personality Disorder (BPD).A Borderline
Personality Disorder Nursing Essay.Staff who come into regular contact with BPD patients
tend to report feelings of demoralisation and anxiety. Many studies report that the main
reason for this is a lack of education surrounding the condition (Woollaston & Hixenbaugh

2008, Krawitz 2004, Cleary et al 2002) and a lack of training on managing BPD patients
(James & Cowman 2007), where it has been shown that staff do not receive adequate
training to meet their needs (Bowers et al 2005). Some studies also indicate a consistent
lack of post-graduate education and, where training was available, it consisted of only one
in-house workshop or lecture (Maltman & Hamilton 2011, James & Cowman 2007).A
Borderline Personality Disorder Nursing Essay.Studies also show that only between 12%
and 46% of staff have undertaken specific training on the care patients with BPD
(Commons-Treloar 2009, Commons-Treloar 2008b, Cleary et al 2002). This training was
mainly through "participation in courses, workshops, clinical supervision
and…lectures" (Cleary et al 2002:187). Another worrying issue is the findings that
education is either not targeted towards its intended staff group (Bowers et al 2005), is
poorly understood by participants (Commons-Treloar 2008b) or is not always available to
unqualified staff, who have high levels of contact with BPD patients and tend to have the
most negative attitudes (Bowers 2006).A Borderline Personality Disorder Nursing
Essay.Differing forms of education have been trailed, with varying success rates, for staff
working with BPD. Studies suggest that workshop training (Maltman & Hamilton 2011,
Krawitz 2004) and lecture based training (Commons-Treloar 2009, Commons-Treloar
2008b) are both successful in achieving attitudinal change towards BPD patients. Common
to all the studies was the incorporation of current research on attitudes towards BPD,
diagnostic criteria, aetiology and causation of the condition, prognosis and deliberations on
the principles of treatment (Maltman & Hamilton 2011, Commons-Treloar 2009, Krawitz
2004) within the training programs.A Borderline Personality Disorder Nursing Essay.In a
study conducted by Maltman & Hamilton 2011, attitudinal change after a two hour
workshop training program was explored. The first part of the program consisted of a
powerpoint presentation providing basic knowledge on BPD, followed by building a
theoretical understanding of BPD behaviour. This program was based on a cognitive-
behavioural model (Cherry 2005) and made use of various case studies. The style of
training allowed for the building of "empathy, understanding and acceptance" (Maltman &
Hamilton 2011: 248).A Borderline Personality Disorder Nursing Essay.Following on were
discussions encouraging group reflection upon problematic behaviours faced by staff such
as team-splitting, persistent complaining and self-harm. This was aimed at exploring and
validating the emotional experiences faced when working BPD.In a similar study, Krawitz
(2004) tested attitudinal change after staff had attended a two-day workshop which was
targeted towards staff working within a variety of inpatient and community settings. The
educational intervention aimed to provide a foundation of "knowledge, skills and language"
(Krawitz 2004:555) which would serve to underpin the future planning of care and help
promote interagency communication. However the study showed some bias in that it was
only directed towards staff wishing to work with BPD.A Borderline Personality Disorder
Nursing Essay.This workshop training explored the commonly accepted principles
surrounding effective crisis and longitudinal treatment plans, in order to provide a
framework for effective treatment and to address the barriers that are presented. It also
provided for the acquisition of practical skills in order to build effective treatment plans.
The workshop content included frameworks such as "the balancing of client and clinician

responsibilities, power and power struggles, acute versus chronic suicidality and the
balancing of short and long term gains" (Krawitz 2004: 555) which was interwoven with
topics such as risk taking, boundaries, staff differences and the importance of monitoring
the clinician's own emotional wellbeing.A Borderline Personality Disorder Nursing
Essay.Krawitz (2004) hypothesised that attending workshop training constructed in this
manner would result in positive attitudinal change. Overall the workshops were positively
received and had a considerable impact upon participants clinical interactions with BPD
patients and helped staff to achieve "realistic hopefulness" (Krawitz 2004:558) and
demonstrated that workshop training can facilitate positive attitudinal change towards BPD
patients.A Borderline Personality Disorder Nursing Essay.Commons-Treloar & Lewis
(2008b) conducted a study looking at attitudinal change following a two-hour teaching
session. The clinical education was split into a ninety minute lecture looking at the concepts
of BPD, incorporating discussions on therapeutic responses to BPD, using three case
studies. At the end of the lecture, all participants were provided with information on BPD in
the form of clinical guidelines on crisis intervention (Mitchell 2000) and national clinical
guidelines on self-harm (NCCMH 2004). Following this, participants attended a thirty
minute seminar to discuss the lecture content.A Borderline Personality Disorder Nursing
Essay.Results from this study demonstrated that there was a significant improvement in
attitudes towards working with BPD patients after targeted clinical education on the
subject. Participants expressed more positive attitudes once they had obtained information
on areas such as diagnosis, aetiology, prevalence rates and "some form of theoretical
frameworks to understanding the behavioural presentation" Commons-Treloar & Lewis
2008b: 985) within BPD patients.A Borderline Personality Disorder Nursing Essay.A similar
study by Commons-Treloar (2009) compared the differences between cognitive
behavioural (CB) and psychoanalytic frameworks as an approach towards training. Both
education programs consisted of two-hour lectures which concentrated on using three
vignettes to discuss and illustrate applicable concepts of the aetiology of BPD. However,
where the cognitive behavioural education group used a dialectic-behavioural approach to
demonstrate the use of self-harm as a means to "regulate overwhelming affective
experiences who had developed affective instability" (Commons-Treloar 2009:1129) due to
childhood invalidation, the psychoanalytic education group covered the theoretical
framework of moral masochism (Freud 2001) to demonstrate how self-harm is used as a
means of managing unconscious feelings of guilt by detailing how the women in the case
study had experienced some form of childhood trauma that was reawakened by some form
of current social stressor.A Borderline Personality Disorder Nursing Essay.Both
conceptualisations concentrated on clinical guidelines on crisis intervention (Mitchell 2000)
and national clinical guidelines on self-harming behaviour (NCCMH 2004) and showed a
significant improvement in attitudes towards working with BPD patients following targeted
clinical education. However, these positive attitudes were only significantly maintained
within the psychoanalytical group, with the cognitive behavioural group attitudinal score
maintained only slightly higher than pre-educational levels at a six month follow-up. This
indicates that training needs to be regularly accessed in order to maintain positive attitudes
towards BPD, which is also a view reflected in other studies (McGrath & Dowling 2012,

Maltman & Hamilton 2011, Commons-Treloar & Lewis 2008a, James & Cowman 2007,
Bland et al 2007, Kurtz 2005, Cleary et al 2002).A Borderline Personality Disorder Nursing
Essay.Many other studies within this dissertation support the need to further explore staff
needs in respect of training and education (Bowers et al 2005, Cleary et al 2002) and
indicate that access to various forms of education are needed to improve attitudes towards
BPD (Maltman & Hamilton 2011, Commons-Treloar 2009, Bowers et al 2005, Krawitz
2004).A Borderline Personality Disorder Nursing Essay.Consistent with educational
thinking stating people learn better when they remain interested and are energised (Griffin
2006) and that didactic teaching can be unproductive if used as the sole teaching style
(Banning 2005), the workshops studies (Maltman & Hamilton 2011, Krawitz 2004) were
participant-centred and interactive. As such they used a multitude of interactional methods
in the forms of powerpoint, audio-visual aids, small group discussions of vignettes and
questions and role-play scenarios. However this does not negate the lecture approach
adopted by Commons-Treloar (2009). Interactive lectures can produce good, learning
outcomes, a deep understanding of learning and provide effective knowledge retention
(Bulstrode et al 2003, Ernest & Colthorpe 2007).A Borderline Personality Disorder Nursing
Essay.Studies discussing the differences in attitudes between male and female staff have
shown more positive attitudes towards BPD (Commons-Treloar & Lewis 2008a,b, Bowers &
Allan 2006) with female staff. This may suggest that different educational strategies are
needed with male staff, however an overall understanding of the aetiology, prevalence,
predisposing (both biological and environmental) factors, concepts, prognosis and both
crisis and longitudinal treatments for BPD remains an important factor regardless of the sex
of the healthcare professional (Maltman & Hamilton 2011, Bowers & Allan 2006, Krawitz
2004).Despite advocating different approaches to education, the above studies all agree
that, in order to maintain high levels of positive attitudes amongst staff, a substantial
investment in staff training needs to be adopted by services (Bowers et al 2005).A
Borderline Personality Disorder Nursing Essay.4. DISCUSSION.4.1 Statement of findings.The
aim of this dissertation was to answer the question "Is targeted clinical education helpful in
improving staff attitudes towards patients with a diagnosis of borderline personality
disorder?"A Borderline Personality Disorder Nursing Essay.The papers examined within
this dissertation have established a clear link between negative behaviour and negative staff
reactions, leading to ongoing negative staff attitudes towards borderline personality
disorder (BPD) patients (McGrath & Dowling 2012, Commons-Treloar 2009). These studies
suggest that an exposure to such behaviours can lead to a decline in staff confidence about
working with BPD patients, polarisation of staffing and negative stereotypical perceptions
being fostered by the staff groups (Woollaston & Hixenbaugh 2008, Bowers et al 2005,
Cleary et al 2002).A Borderline Personality Disorder Nursing Essay.Attitudes towards
people with a diagnosis of BPD tend to be more negative than those towards other mental
health illnesses such as schizophrenia, depression and bi-polar disorder which is consistent
with other studies carried out within this area (Markman & Trower 2003, Bland 2007,
Mason et al 2010, Winship 2010). These pessimistic attitudes can act as a barrier to
effective care services for people with BPD (James & Cowman 2007,Cleary et al 2002).
However not all staff display negative attitudes; some positive attitudes and willingness to

help do exist (Maltman & Hamilton 2011, Bowers et al 2006) These positive attitudes derive
from a number of sources, namely education on BPD, staff support structures, getting to
know the client's psychosocial history and staff's willingness to help (Commons-Treloar
2009, Bowers et al 2006, Krawitz 2004)A Borderline Personality Disorder Nursing
Essay.This literature review has revealed a positive correlation between attitudinal change
and education supported in literature. Cleary et al (2002) provided useful evidence which
demonstrated staff willingness to attend further education and training on BPD to help
facilitate effective treatment and management. This is further supported by studies that
endorse the use of education and training to provide a greater understanding of BPD
(Woollaston & Hixenbaugh 2008, Bowers et al 2005) ergo, staff using the increased
knowledge in the context of more productive client to staff interactions and tolerance
(James & Cowman 2007, Bowers et al 2005). Providing staff with a better understanding of
the complexities of BPD will allow them to respond both therapeutically and with reduced
negativity in times of crisis (McGrath & Dowling 2012).A Borderline Personality Disorder
Nursing Essay.4.2 Critique of my literature review process.Due to both time and monetary
restraints, some articles that would have aided in this dissertation could not be accessed.My
literature was limited to English language articles due to my only speaking this language.
Although this limitation is not uncommon (Aveyard 2010), it should be noted that non-
English papers were available which may have contributed to a better understanding of the
issues within this dissertation but which could not be translated within the timeframe of
this dissertation project.A Borderline Personality Disorder Nursing Essay.My electronic
database searching was thorough by use of cutting and pasting my search terms into each
database, thus negating the chance of typing errors occurring and increasing the reliability
of my results. My choice of databases was comprehensive and allowed for the collection of
all relevant articles. However my hand searching of journals was compounded by time, as
such I only had time to read the abstracts of some articles as opposed to the full paper. This
could have resulted in the rejection of articles that may have been relevant to this
dissertation.A Borderline Personality Disorder Nursing Essay.5. CONCLUSION.5.1
Conclusion.Borderline personality disorder (BPD) is a difficult diagnosis for both patients
and staff. The behavioural difficulties encountered within BPD can be damaging to the
therapeutic relationship, which in turn can directly impact on recovery. The issue of
negative attitudes and behaviours amongst healthcare professionals is an unpalatable
thought, where the negativity displayed works against the principles of beneficence,
nonmaleficence and equality, principles that the nursing profession as a whole consider
highly.A Borderline Personality Disorder Nursing Essay.Targeted education surrounding
aetiology, understanding and awareness of treatment and management options has been
shown to combat existing negative and stigmatising attitudes towards BPD. However the
findings of this dissertation indicate that, although education has been shown to improve
attitudes towards BPD, there is no clear style of education that provides the best outcomes.
It is therefore hypothesised that a multifaceted approach to clinical education and ongoing
training needs should adopted in order to maintain positive attitudes and provide the best
overall results. Different staff populations need different forms of training; therefore
targeting educational needs to specific staff groups will provide better outcome measures in

respect of attitudinal change.A Borderline Personality Disorder Nursing Essay.Despite the
clear recognition of this particular group of patients' need for care, the diagnosis of BPD and
its treatability is still a hotly contested area. However this is slowly changing with policy
and guidance surrounding the care of personality disorders having grown exponentially
over the years, culminating in NICE producing guidelines on the care and treatment of BPD
in 2009. Since then we have seen the rise of good comprehensive and integrated services
that are based on sound multi-disciplinary and multi-agency teamworking being
developed.A Borderline Personality Disorder Nursing Essay.In answering my research
question of Is targeted clinical education helpful in improving staff attitudes towards
patients with a diagnosis of borderline personality disorder? I can now say that I believe
that it is. However this dissertation has only uncovered the tip of the iceberg when looking
at attitudes and training needs.5.2 RecommendationsThe use of education as a means of
changing negative staff attitudes towards BPD needs to be core to any service dealing with
this difficult and demanding patient group.A Borderline Personality Disorder Nursing
Essay.Services need to see training as an essential component. As such they need to invest
in structured training for both non-qualified and post-graduate staff in order to maintain
positive, empathetic and person-centred care.Training can take many forms but should
provide debate surrounding the concepts of BPD, psychopathy and the negative impact of
pejorative labelling.Staff should be educated in the complexity of causal models for BPD
problems and behaviour.More research needs to be conducted into why female staff have a
more empathetic attitude to BPD behaviours.A Borderline Personality Disorder Nursing
Essay.5.3 Implications for practice.The implications for practice on providing targeted
clinical education are that newly learned skills and positive attitudinal change towards BPD
patients can alleviate the negative experiences of working with BPD patients, hence
influence the quality of care. When staff feel more empathy and optimism towards patients
with a diagnosis of BPD they will be able to provide better holistic care that is focused
towards recovery.A Borderline Personality Disorder Nursing Essay.5.4
Reflection.Completing this dissertation has been challenging, mainly due to my experience
as a novice researcher, resulting in the literature review being less than perfect. However,
the process of the literature review taught me the importance of finding and applying the
most up-to-date evidence to my practice and has made me more confident in about
appraising evidence in my future career.I feel that I have benefited from the writing of this
dissertation as it has greatly helped me in consolidating my mental health nursing practice
as well as challenging some of my own preconceived ideas surrounding staff's negative
feelings, making me realise that they are borne out of feelings of frustration, hopelessness
and helplessness as opposed to feelings of dislike for the patient. This will greatly benefit
me in the future when working with BPD patients and the staff who regularly look after
them.A Borderline Personality Disorder Nursing Essay.