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危机解决家庭治疗小组临床医生对使用恢复方法治疗被诊断为边缘型人格障碍患者的看法。

Crisis resolution home treatment team Clinicians' perceptions of using a recovery approach with people with a diagnosis of borderline personality disorder.

机构信息

Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK.

University of Chester, Chester, UK.

出版信息

J Psychiatr Ment Health Nurs. 2023 Jun;30(3):558-567. doi: 10.1111/jpm.12891. Epub 2023 Jan 12.

Abstract

WHAT IS KNOWN ON THE SUBJECT?: It is known that people with a diagnosis of borderline personality disorder often experience crises in their mental wellbeing. There is little evidence about the approaches of mental health nurses in community-based crisis teams when working with people with a diagnosis of BPD. WHAT THE PAPER ADDS TO THE EXISTING KNOWLEDGE?: This paper highlights that limited resources, work-patterns and issues of stigma present challenges to delivering recovery-oriented care. The paper highlights that nurses typically try to navigate the challenges to continue to provide individualized care, though their self-assessment is that this is with mixed success. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that support is needed to develop brief interventions specific to teams working with people with a diagnosis of BPD who are at a point of crisis. ABSTRACT: Introduction People with a diagnosis of borderline personality disorder (BPD) are often in contact with mental health services at a point of crisis, and in the UK, this includes Crisis Resolution Home Treatment teams (CRHTT). There is a drive for services to be recovery orientated; however, there is little evidence about the degree to which community services achieve this for people with a diagnosis of BPD when in crisis. Research Aim To understand the perceptions held by CRHTT clinicians about their provision of recovery-orientated acute care, for people with a diagnosis of BPD. Method From a purposive sample of a single CRHTT, seven registered mental health nurses were interviewed and Braun and Clarke's thematic analysis framework was used to interpret the data. Results Five themes emerged: person-centred care; the timing is wrong; inconsistent staffing; the risks are too great; and BPD as a label. Discussion The results demonstrate tensions between a drive to deliver person-centred care and a range of challenges that inhibit this, with the possibility of reframing a recovery approach as "recovery-ready". Implications for Practice A whole-system approach is required to enable a consistent recovery-oriented approach, but research is also needed for brief interventions specific to this context.

摘要

已知患有边缘型人格障碍的人经常会经历心理健康危机。关于社区危机团队中的心理健康护士在与被诊断为 BPD 的人一起工作时的方法,几乎没有证据。

本文的贡献在于,有限的资源、工作模式和耻辱感问题给提供以康复为导向的护理带来了挑战。本文强调,护士通常会努力应对这些挑战,继续提供个性化护理,尽管他们自我评估的成功率参差不齐。

这对实践有什么影响?调查结果表明,需要支持为与处于危机中的被诊断为 BPD 的人一起工作的团队制定特定的简短干预措施。

简介 患有边缘型人格障碍(BPD)的人经常在危机时刻与心理健康服务部门联系,在英国,这包括危机解决家庭治疗团队(CRHTT)。服务以康复为导向的趋势正在推动,但几乎没有证据表明社区服务在人们处于危机时为患有 BPD 的人实现这一目标的程度。

研究目的 了解 CRHTT 临床医生对为被诊断为 BPD 的人提供以康复为导向的急性护理的看法。

方法 从一个单一的 CRHTT 中进行了有针对性的抽样,对七名注册精神科护士进行了访谈,并使用 Braun 和 Clarke 的主题分析框架对数据进行了解释。

结果 出现了五个主题:以患者为中心的护理;时机不对;人员配置不一致;风险太大;以及 BPD 作为一个标签。

讨论 结果表明,在提供以患者为中心的护理的动力与一系列抑制这种护理的挑战之间存在紧张关系,有可能将康复方法重新定义为“康复准备就绪”。

对实践的影响 需要采取全系统方法来实现一致的以康复为导向的方法,但也需要针对这种情况的具体简短干预措施的研究。

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