Key stakeholders' experiences and expectations of the care system for individuals affected by borderline personality disorder: An interpretative phenomenological analysis towards co-production of care.

BACKGROUND: The diagnosis of borderline personality disorder (BPD) consists of extreme emotional dysregulation and long-term disability when left untreated. It is associated with ineffective use of health care systems and mismanaged care in emergency departments, which can result in a revolving door phenomenon of urgent system usage, poor treatment outcomes, or patients falling out of care entirely-all of which primarily affect patients with BPD as well as their caregivers and clinicians. This crisis must be addressed with a comprehensive understanding of key stakeholder perspectives on the challenges of the system and potential solutions. OBJECTIVE: This study explored the perspectives of three key stakeholder groups (i.e., patients, clinicians, and caregivers) in relation to their experiences with and future expectations of the care system for those affected by BPD. METHODS: Four patients with BPD, three generalist clinicians with experience treating BPD, and three caregivers of individuals with BPD participated in individual semi-structured interviews. Participants were asked about their experiences with the current healthcare system and their suggestions for improvement. Responses were analyzed using interpretative phenomenological analysis. FINDINGS: In-depth analysis of the qualitative data revealed twelve shared themes and three themes that were unique to each key stakeholder group. These themes are discussed and used to inform recommendations for promising practices, policies, and training in this area. CONCLUSION: Findings support the importance of a comprehensive mental health system approach for improving the accessibility, effectiveness, and acceptability of the management and treatment of BPD.

Bridging the Gap in Community Care for Patients With Borderline Personality Disorder: Protocol for Qualitative Inquiry Into Patient, Caregiver, and Clinician Perspectives on Service Gaps and Potential Solutions for Severe Emotion Dysregulation.

BACKGROUND: Borderline personality disorder (BPD) is characterized by severe emotion dysregulation that is often complicated by comorbid diagnoses, deliberate self-harm, and chronic suicidal ideation. Unfortunately, current care pathways for individuals with BPD are strained by limited resources, inadequate training, and an overuse of emergency departments and crisis teams. Such barriers result in delayed access to effective treatment, which increases risk of deterioration, disability, and morbidity. A first step toward addressing these limitations of the current care pathway is to understand key stakeholders' lived experiences in this pathway and their perspectives on potential solutions. OBJECTIVE: The purpose of this paper is to present a protocol for a study that explores the lived experiences of the current care pathway from the perspectives of patients with BPD, as well as their caregivers and clinicians. METHODS: A qualitative approach is most appropriate for the exploratory nature of the research objective. Accordingly, 3 to 6 patients with a diagnosis of BPD, 3 caregivers of individuals with BPD, and 3 clinicians of patients diagnosed with BPD will be invited to participate in individual, semistructured interviews that focus on service experiences. RESULTS: It is anticipated that results will yield insight into the lived experiences of patients with BPD, caregivers, and clinicians and provide a better understanding of the perceived gaps in services and potential solutions. Results are expected to be available in 12 months. CONCLUSIONS: This paper describes a protocol for a qualitative study that seeks to understand the lived experiences and perspectives of key stakeholders (patients, caregivers, and clinicians) on the current care pathway for BPD. Results will provide a basis for future research in this area and will have the potential to inform training, practice, and policy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14885.

Family Members' Perspectives of Health Care System Interactions With Suicidal Patients and Responses to Suicides: Protocol for a Qualitative Research Study.

BACKGROUND: Suicide is a major cause of preventable death globally and a leading cause of death by injury in Canada. To support people who experience suicidal thoughts and behaviors and ultimately prevent people from dying by suicide, it is important to understand the individual and familial experiences with the health care system. OBJECTIVE: This study aims to explore how suicide victims, and their family members, interacted with the health care system. METHODS: We will invite family members of 6 to 8 suicide victims to participate in the study by sharing their perspectives on both their relative's as well as their own interactions with the health care system. Interviews will take place in-person and will be audio recorded, transcribed, and analyzed thematically. RESULTS: The results of the study are expected to be available in 12 months. We expect the results to shed light on the experiences of suicide victims and their family members with the health care system. CONCLUSIONS: Our study results may inform practice, policy, and further research. They may shape how members of the health care system respond to people who are at risk of suicide and their families. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/13797.

Atención del parto y del puerperio inmediato con pertinencia intercultural / Care of childbirth and immediate puerperium

PROPÓSITO: Explorar los factores que influyen en la aplicación de la interculturalidad con respecto a la atención del parto y puerperio inmediato en personal médico y paramédico, comadronas y usuarias del Centro de Urgencias Médicas (CUM) de Tecpán, Chimaltenango, abril-mayo 2017. MATERIAL Y MÉTODOS: Estudio cualitativo con diseño etnográfico. Se realizaron entrevistas en profundidad al personal de salud y usuarias del CUM y grupos focales con comadronas. Se evaluó la infraestructura de las salas de parto y posparto. RESULTADOS: En el personal médico y paramédico se evidenciaron saberes limitados acerca de la pertinencia cultural, descrita en las Normas de Atención con Pertinencia Cultural. Se contó con el 65% de los elementos de infraestructura y equipo de la sala de partos culturalmente adecuada. Las comadronas percibieron una atención deficiente y refirieron poco interés y capacitación del personal del servicio de salud. Las usuarias opinaron que existe una buena relación con el personal de salud, sin embargo no se les brindó una atención con adecuación cultural. CONCLUSIONES: Los factores que influyen en la implementación de las prácticas interculturales son de índole económica principalmente, además de aspectos estructurales, organizaciones y socioculturales.

PURPOSE: To explore the factors that influence the implementation of interculturality in regards to care during childbirth and the immediate postpartum period, in medical and paramedical staff, traditional midwives and patients of the Center of Medical Urgencies (CUM), Tecpán, Chimaltenango, April-May 2017. MATERIALS AND METHODS: Qualitative study with an ethnographic design. In-depth interviews with medical staff and patients of the CUM were carried out in addition to focal groups with traditional midwives. The infrastructure of the birthing room and postpartum ward were evaluated. RESULTS: CONCLUSIONS: The medical and paramedical staff showed limited awareness of cultural pertinence, as described in the Norms of Attention with Cultural Pertinence. The birthing room satisfies 65% of the criteria of infrastructure and equipment of a culturally pertinent birthing room. The traditional midwives perceived deficient patient care and identified a lack of interest and training of the health staff. The patients experienced a good relationship with the health staff, but declared a lack of cultural adequacy in the attention. The factors that influence in the implementation of intercultural practices are principally of economic nature, in addition to structural, organizational and sociocultural aspects.