Cultural Representations of Borderline Personality Disorder.

Background/Objective: Borderline Personality Disorder (BPD) is characterized by unstable interpersonal relationships, impulsivity, and self-harm. There are many distinct stressors that predispose individuals to develop BPD or engage in self-harm behaviors. The objective of this systematic review was to compare methods of self-harm and psychological stressors in BPD across different cultures. Methods: A PubMed database search was conducted with the goal of capturing all articles (n = 22) that discussed methods of self-harm in BPD in any culture. Data extracted from the articles included methods of self-harm, psychological stressors, sample size, rurality, geographical location, and proportion of males to females. Results: Key differences were noted in the methods of self-harm. Eastern nations (n = 5) reported higher rates of self-poisoning (60%) than Western nations (11%). Western nations (n = 9) reported higher rates of skin-mutilating behavior (100%) than Eastern nations (80%). Two of the articles included participants from rural settings, one in the Sundarban region of India and the other in Mississippi. Notably, the Sundarban region reported the highest rate of poisoning (93%) whereas the Mississippi region reported high rates of skin mutilation. Differences were also noted in psychological stressors as the rates of interpersonal problems were higher in Western than in Eastern nations. Conclusions: Additional research should be conducted into the presentation of BPD in different cultures. An improved understanding of the cultural presentations of BPD could improve diagnosis and treatment in various populations.

Color Coding the "Labyrinth": How Staff Perceived a Two-Part Intervention to Improve Wayfinding in an Adult Emergency Department.

OBJECTIVES, PURPOSE, OR AIM: We report a two-part wayfinding intervention, considering four quality criteria (visibility, usability, efficiency and overall effectiveness) from staff perspectives. BACKGROUND: Few studies to date have explored wayfinding in the Emergency Department (ED). Yet, as ED usage continues to grow, effective wayfinding in these high-stress, fast-paced environments is likely to become increasingly important. At an adult ED located in the U.S. Southeast, wayfinding has been a persistent problem. We subsequently developed a two-part wayfinding intervention: colored routes to key destinations in the ED and corresponding visitor badges. METHODS: Quality criteria were formulated using the Donabedian model: visibility (structure), usability (process), efficiency (process), and overall effectiveness (outcome). Assessments consisted of staff surveys, which were distributed from March to early April 2019. RESULTS: The strong ratings across quality criteria, added to affirmative comments from staff, provide evidence that the color coding system made a positive impact on wayfinding. CONCLUSIONS: While the results should be generalized with caution, the two-part intervention may be highly portable to other contexts. Future studies might examine the effect of colored routes alone. They might illuminate relations between structure, process, and outcomes as they relate to the assessment of wayfinding. They might also expand wayfinding quality criteria. Ultimately, such studies should improve not only the productivity but also the accessibility and user experience of the ED.