[Cognitive model for behavioural interventions for personality disorders in older adults: a nursing approach]. / Mediatietherapie bij ouderen met een persoonlijkheidsstoornis: Een verpleegkundige benadering.

Behavioural counselling by nurses can enhance quality of life in elderly with a personality disorder. Although nurses have a crucial role in day-to-day treatment, there is a lack of evidence-based approaches. Based on the cognitive therapy, the treatment protocol Cognitive Model for Behavioural Interventions (CoMBI) provides an alternative nursing approach for personality disorders.

[Lack of empathy in teenagers, a weakness in the therapeutic relationship]. / Le déficit d'empathie chez l'adolescent, une faille dans la relation thérapeutique.

The capacity to recognise others as being different from oneself is an essential element of empathy. Achille's treatment in a child psychiatry unit illustrates the clinical presentation of a teenager who lacks this social skill. The use of the Griffith Empathy Measure improves the screening and evaluation of this disorder, with the aim of being able to provide the young patient with adapted support.

A focus group study exploring student nurse's experiences of an educational intervention focused on working with people with a diagnosis of personality disorder.

WHAT IS KNOWN ON THE SUBJECT?: Research has consistently shown that poor attitudes exist in mental health care towards people with a diagnosis of personality disorder and that nurses can find working with this group of patients professionally and personally challenging. Power imbalances of practitioner over students exist on training placements. This can result in students being exposed to negative attitudes towards service users with a diagnosis of personality disorder and not feeling able to challenge these attitudes. The Knowledge and Understanding Framework (KUF) is a specialist programme of personality disorder training that has demonstrated effectiveness with qualified mental health professionals. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Although the subject of personality disorder is considered within preregistration education, an opportunity for a more robust approach to supporting student's nurses with this complex subject area is required (Ross & Goldner 2018). Attempts to integrate and evaluate specific educational interventions of this nature into preregistration nurse education have not been explored elsewhere. This study utilized focus groups to examine the experience of the KUF training and the perceived impact on attitudes and approaches to personality disorder of a group of nursing students who had completed the KUF programme. The students exhibited positive attitudes towards people with a diagnosis of personality disorder and confidence to influence negative attitudes in practice. The KUF shifted the students' focus from identifying patient behaviours as problematic towards an understanding of these difficulties arising from their own emotional responses. This was a small study so the results should be treated with caution. There was no follow-up once the students had qualified, so it is not clear whether such effects would endure long term. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Training students using the KUF may foster positive attitudes to people with a diagnosis of personality disorder and provide them with the skills to positively influence other colleagues practice. ABSTRACT: Introduction Negative attitudes exist in practice towards those with a diagnosis of personality disorder. Preregistration training offers the opportunity to address this by developing understanding of the diagnosis, confidence in working with people with the diagnosis and empowering new nurses to challenge prevailing attitudes. Attempts to integrate and evaluate specific educational interventions of this nature into preregistration nurse education have not been explored elsewhere. Aim To explore preregistration, nurses' experience of a programme of training focused on personality disorder and their perception of its influence on attitudes, understanding of clients and their experience of practice. Method A qualitative study using thematic analysis of two focus groups of preregistration mental health nursing students. Results Evidence of positive attitudes and confidence to supportively challenge negative attitudes in practice were found. Students showed a shift away from a focus on changing the perceived "difficult" behaviour of a client towards an understanding of their own emotional responses to the behaviours. Discussion The Knowledge and Understanding Framework training shows potential for students to change attitudes and develop progressive practice working with people with personality disorder. Implications for practice The integration of the Knowledge and Understanding Framework should be considered as part of preregistration training. Further research into the sustained influence of the training post registration is required.

Nursing diagnoses related to psychiatric adult inpatient care.

AIMS AND OBJECTIVES: To detect the prevalence of NANDA-I diagnoses and possible relationships between those and patient characteristics such as gender, age, medical diagnoses and psychiatric specialty/setting. BACKGROUND: There is a lack on studies about psychiatric inpatient characteristics and possible relationships among these characteristics with nursing diagnoses. DESIGN: A quantitative-descriptive, cross-sectional, completed data sampling study was performed. METHODS: The data were collected from the electronic patient record system. Frequencies for the social-demographic data, the prevalence of the NANDA-I diagnoses and the explanatory variables were calculated. RESULTS: In total, 410 nursing phenomena were found representing 85 different NANDA-I diagnoses in 312 patients. The NANDA-I diagnosis "Ineffective Coping" was the most frequently stated diagnosis followed by "Ineffective Health Maintenance," "Hopelessness" and "Risk for Other-Directed Violence". Men were more frequently affected by the diagnoses "Ineffective Coping," "Hopelessness," "Risk for Self-Directed Violence," "Defensive Coping" and "Risk for Suicide," whereas the diagnoses "Insomnia," "Chronic Confusion," "Chronic Low Self-Esteem" and "Anxiety" were more common in women. Patients under the age of 45 years were more frequently affected by "Chronic Low Self-Esteem" and "Anxiety" than older patients. "Ineffective Coping" was the most prevalent diagnosis by patients with mental disorders due to psychoactive substance use. Patients with schizophrenia were primarily affected by the diagnoses "Ineffective Coping," "Impaired Social Interaction" and "Chronic Low Self-Esteem." CONCLUSIONS: This study demonstrates the complexity and diversity of nursing care in inpatient psychiatric settings. Patients' gender, age and psychiatric diagnoses and settings are a key factor for specific nursing diagnosis. RELEVANCE TO CLINICAL PRACTICE: There are tendencies for relationships between certain nursing diagnosis and patient characteristics in psychiatric adult inpatients. This enhances the specific, extended knowledge for nursing care and its demands in this setting and therefore supports the daily nursing psychiatric care and its needs.

Mechanical restraint and characteristics of patient, staff and shifts in a psychiatric ward.

BACKGROUND: The use of coercion is a balance between depriving the patients' autonomy and dignity and preventing endangerment of the body or health of self or others. It is of importance to obtain more knowledge about mechanisms leading to mechanical restraint in the attempt of reducing it. OBJECTIVE: To analyse for associations between incidence of mechanical restraint (MR) and staffing level, staff demographics, patient characteristics, type of shift (day/evening/night) and change of shifts. METHOD: A naturalistic descriptive method was used to study cases of MR in a psychiatric ward. Data for each case of MR was obtained from an electronic reporting system. Care workers from each shift were identified using duty rosters. Analyses included binary logistic regression analyses. RESULTS: In 82% of the 114 cases of MR, the patient was diagnosed with personality disorders. In the multiple regression analysis, a significant association was found between the use of MR and the presence of male care workers on the ward (OR:1.44, 95% CI: 1.01-2.05; p = .04). Moreover, MR was associated with evening shifts, compared with day and night shifts (OR =1,29, 95% CI: 1.14-2.57, p = .01). Besides, months from January to December was associated with a decrease in MRs (OR: 0.88, 95% CI: 0.83-0.94; p = 7.3 E-6). No significant associations were found between MR and staffing level or experience. CONCLUSIONS: MR was associated with evening shifts, higher number of male care workers on duty and a decrease from January to December.

Picturing the Experience of Living With Myotonic Dystrophy (DM1): A Qualitative Exploration Using Photovoice.

BACKGROUND: Myotonic dystrophy presents with multisystemic complications, and there is a well-recognized myotonic dystrophy personality profile that is characterized by executive dysfunction, an avoidant personality, and impaired cognition. Understanding symptom impact on patients' lives is crucial for providing appropriate patient-centered care; however, much of the myotonic dystrophy literature reflects the biomedical model, and there is a paucity of articles exploring patient experience. OBJECTIVE: The aim of this study was to use a novel research approach to explore the experiences of patients with myotonic dystrophy. METHODS: Nine individuals participated in a qualitative study using the photovoice method. Photovoice uses the visual image to document participants' lives, and participants took pictures pertaining to living with myotonic dystrophy that stimulated individual and focus group interviews. We used content analysis to analyze the data; in turn, codes were collapsed into themes and categories. Findings were presented to participants to ensure resonance. RESULTS: Participants took 0-40 photographs that depicted barriers and facilitators to living successfully with myotonic dystrophy. We identified two categories that include participants' challenges with everyday activities, their worries about the future, their grief for lost function and social opportunities, and their resilience and coping strategies. Participants also described their experiences using the photovoice method. CONCLUSION: Photovoice is a useful approach for conducting research in myotonic dystrophy. Participants were active research collaborators despite perceptions that individuals affected with myotonic dystrophy are apathetic. Our findings suggest that participants are concerned about symptom impact on reduced quality of life, not symptoms that clinicians preferentially monitor. Nurses, therefore, are essential for providing patient-centered, holistic care for patients' complex biopsychosocial needs. Research exploring current physician-led clinical care models is warranted.

[Tony, at risk of getting lost]. / Tony, au risque de s'y perdre.

For some long-term hospital patients, certain care options involve risk-taking for the patient and for the teams. The assessment of these risks, even if they are to some extent unknown, must be discussed and weighed up. The teams must therefore anticipate situations and find alternatives which will ensure the success of the project.

How do nurses experience working with adolescents with a diagnosis of 'personality disorder' or 'emerging personality disorder'?

Nurses experience adults with a diagnosis of 'personality disorder' ('PD') as challenging, but nothing is known of their experiences working with young people with a diagnosis of 'PD' or 'emerging PD'. This study aimed to explore the experiences of nurses with this group. Six nurses were interviewed individually and the transcripts analysed employing interpretative phenomenological analysis. Two themes were identified: emotional impact, and conflict and need for support. Participants described powerful emotional responses and heavy time demands as particular challenges. They also reflected on tensions that arose in the wider team and service context. The importance of reflective space, training and the need for specialist approaches, such as therapeutic input, was emphasized by all participants. The study's findings suggest that while there are some similarities to adult services, there are also issues specific to nursing adolescents with 'PD', which merit further attention, including the implications of the lack of diagnostic clarity for treatment approaches and the difficult interpersonal dynamics of the condition. Recommendations for practice include additional training in relation to the theoretical understanding of diagnosis itself and in working therapeutically with young people with the diagnosis, employing approaches that have been found to be useful in adult services.

'It's one of the hardest jobs in the world': the experience and understanding of qualified nurses who work with individuals diagnosed with both learning disability and personality disorder.

BACKGROUND: This study examines the experiences of qualified nurses working with individuals diagnosed with both intellectual disability and personality disorder (PD) in a medium-secure forensic intellectual disability setting. Potential training needs are highlighted, as well as other ways in which services could better support staff to work effectively with this client group. METHOD: In-depth, semi-structured interviews were used to explore the nine participants' experiences; the narratives were analysed with interpretative phenomenological analysis (IPA). RESULTS: Four master themes emerged from (i) disorder overriding disability; (ii) resilience; (iii) ambivalence towards label and (iv) knowledge. CONCLUSION: The findings highlight that for these participants, the clients' intellectual disability appeared to be lost under the complexity of the PD diagnosis. The clinical implications are discussed in terms of developing training, supervision and support.

Acceptance and commitment therapy-based self-management versus psychoeducation training for staff caring for clients with a personality disorder: a randomized controlled trial.

People diagnosed with a personality disorder (PD) are often a stigmatized patient group. This can affect the care they receive, their progression, and the well-being of staff caring for them. Interventions targeted at health care professionals that aim to improve attitudes toward these patients and improve staff well-being do exist; however, evidence for their effectiveness is limited. The present study compared a self-management, Acceptance and Commitment Therapy-based training intervention (ACTr) with a Psychoeducation Training (PETr) intervention in their effectiveness in improving attitudes toward PD patients, staff-patient relations, and staff well-being. Both interventions were successful at improving attitudes and measures of staff-patient relations up to 6 months after training; however, staff well-being did not change for either group. The implications for staff training and future research are discussed.

Profiling frequent presenters to the emergency department for mental health complaints: socio-demographic, clinical, and service use characteristics.

BACKGROUND: A small subset of individuals makes a disproportionate number of ED visits for mental health complaints. STUDY OBJECTIVES: To explore the population profile and associated socio-demographic, clinical, and service use factors of individuals who make frequent visits (5+ annually) to hospital EDs for mental health complaints. METHODS: Case-control study using electronic health record data. RESULTS: Frequent presenters represented 3% of mental health ED patients and accounted for 18% of visits. Several factors were significantly associated with frequent ED use, including limited social support, documented personality disorder/traits, regular antipsychotic use, self-reported alcohol use, and having multiple referral sources.

[The management of perpetrators of sexual violence]. / La prise en charge des auteurs de violence sexuelle.

Sexual violence and crimes arouse rejection and hatred in our society. Perpetrators of sexual violence must comply with psychiatric treatment, without necessarily having requested it. Caregivers find it extremely difficult to engage themselves in the management of these patients. This context has favoured the setting up of specific consultations, signalling a potential new area of care.

Forensic nursing interventions with patients with personality disorder: a holistic approach.

Research findings suggest that nursing assessment and care and psychotherapy of forensic patients with personality disorder should be based on a holistic approach that addresses a wide range of their needs. Such an approach should be in collaboration with patients, informal carers, and other professionals and informed by appropriate education, training, clinical supervision, and support. Holistic care includes areas (such as physical health, cultural, spiritual, and psychosexual needs) that are addressed to a limited extent in the literature on patients with personality disorder. Despite limitations in research evidence, findings suggest that some patients with personality disorder benefit from psychotherapies, sometimes facilitated by nurse-therapists, and therapeutic community principles. These interventions should take account of patients' cultural and spiritual needs and perspectives. Helping patients to manage anger has potentially positive consequences for their physical health, personal and work relationships, and other areas. Research is needed to consider how to deliver holistic care with limited resources and in organizations, such as prisons, with conflicting goals.

Decreased risk for violence in patients admitted to forensic care, measured with the HCR-20.

AIM: The aim of this study was to explore if patients admitted to forensic psychiatric care decreased their assessed risk for violence over time, to identify patients who decreased their assessed risk for violence exceptionally well (30% or more) on the clinical (C) and risk management (R) scales in the (HCR-20), and to compare them in terms of demographic data. METHODS: The HCR-20 risk assessment instrument was used to assess the risk for violence in 267 patients admitted to a Swedish forensic psychiatric clinic between 1997 and 2010. Their assessments at admission were compared with a second, and most recent, risk assessment. RESULTS: The risk for violence decreased over time. Demographic criteria had no impact on differences on decreased risk. Only two factors, namely gender and psychopathy showed a difference. Risk factors associated with stress and lack of personal support were the items that turned out to be the most difficult to reduce. CONCLUSION: The results show that risk prevention in forensic care does work and it is important to continue to work with risk management. The study highlights the importance of a careful analysis of the patient's risk for violence in order to work with the patient's specific risk factors to reduce the risk.

[The illustrated depression scale, an innovative tool]. / L'echelle de depression illustrée, outil innovant au quotidien.

As an aid to daily practice in mental health, the Fribourg Mental Health Network in Switzerland has developed an innovative tool to measure the symptoms of depression, the Illustrated Depression Scale. It provides a simple and quick assessment of the symptoms of depression and their evolution during hospitalisation.This article gives an overview of the development of this scale, its psychometric qualities and its use in practice.

Improving services for people with personality disorders: views of experienced clinicians.

People with personality disorders are frequent users of both inpatient and outpatient psychiatric services, representing a significantly large proportion of all mental health clients. Despite this, most services find it a challenge to offer the most appropriate and effective treatment models for people with personality disorders. This paper is a report of a study of clinician opinions about how organizations can improve the delivery of services to people with personality disorders. Data was collected from experienced clinicians attending a personality disorders clinical and scientific meeting who were asked to work together in groups and present solutions for how organizations can improve the services provided to people with personality disorders. Qualitative data was collected and thematically and semantically analyzed using Nvivo and Leximancer. The Nvivo analysis revealed five main areas in which clinicians believe organizations can improve services for people with personality disorders. These focused on: (i) more training and education for health professionals and carers; (ii) better support through supervision and leadership; (iii) adoption of a more consistent evidence-based approach to client management and treatment; (iv) clearer guidelines and protocols; and (v) changed attitudes about personality disorder to decrease stigma. The Leximancer analysis of responses indicated the identified themes were not distinct; rather they were interconnected and related to one another, semantically. In summary, clinicians across a large and diverse geographical area developed a consensus that mainstream management of personality disorder is largely poor and inadequate. The findings lend support to an integrative and collaborative whole-service approach that enhances evidence-based practice in the community.