Faculty of Health, Liverpool John Moores University, Liverpool, UK.
Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK.
J Psychiatr Ment Health Nurs. 2024 Feb;31(1):55-65. doi: 10.1111/jpm.12959. Epub 2023 Aug 1.
WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Personality disorder is a serious mental health condition affecting up to 52% of psychiatric outpatients and 70% of inpatients and forensic patients. People with a diagnosis of personality disorder have higher morbidity and mortality than those without. Service users and carers reported a lack of training for staff in the management of individuals with a diagnosis of personality disorder, particularly with regard to self-harm and suicidal behaviours. Staff burnout creates barriers to compassionate person-centred care for individuals with a diagnosis of personality disorder as staff struggled to accommodate the nature of the presentation when under significant emotional, psychological and professional strain caused by understaffing and lack of support. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper adds new knowledge by informing services of ways to improve care provision from the perspectives of both carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with a diagnosis of a personality disorder should be adopted, and personality disorder training introduced for all healthcare practitioners, to improve patient outcomes.
INTRODUCTION: There is limited understanding of the experience of people with complex mental health (CMH) needs, including those with a diagnosis of personality disorder (PD) and carers of those individuals. Little is known about carers of those in inpatient forensic settings, yet it has been identified that they may have additional needs when compared to general carers. Research highlights that community carer support services were perceived as inadequate and out-of-area placements were described as putting an added strain on ability to support loved ones. Understanding PD within a population of people with CMH needs and how a diagnosis described as PD impacts on care and treatment experience is vital to providing high-quality care.
To evaluate the care experience of service users and carers with lived experience of a diagnosis of PD and out-of-area placements.
Semi-structured interviews were conducted with six service users and four carers to explore the experiences and perspectives of people with a diagnosis of PD. Interviews were audio recorded and thematically analysed.
Four interrelated themes were developed; Influence of a diagnosis of PD on Staff, Early and Appropriate Intervention, Recognition of the Individual and Training and Knowledge of people with a diagnosis of PD.
Anti-stigma interventions for staff, research on care provision and structural changes to services including more evidence-based therapy for individuals with a diagnosis of PD may help reduce disparate treatment and improve prognosis for recovery.
This paper informs services of ways to improve care provision from the perspective of carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with diagnoses of PD should be adopted, and PD training for all healthcare practitioners to improve patient outcomes.
本文的新增内容是什么？人格障碍是一种严重的心理健康状况，影响到 52%的精神科门诊患者和 70%的住院患者和法医患者。被诊断为人格障碍的人比没有被诊断为人格障碍的人发病率和死亡率更高。服务使用者和照顾者报告说，工作人员在管理被诊断为人格障碍的个人方面缺乏培训，特别是在自我伤害和自杀行为方面。工作人员的倦怠感会阻碍对被诊断为人格障碍的个人进行富有同情心的以患者为中心的护理，因为工作人员在人手不足和缺乏支持的情况下，在情绪、心理和专业压力下，难以适应患者的表现。这对实践有什么影响？本文从照顾者和服务使用者的角度为服务提供了改善护理的新方法，增加了新知识。应该采用更全面和较少医学化的方法来治疗与人格障碍诊断相关的问题，并为所有医疗保健从业者引入人格障碍培训，以改善患者的治疗效果。
引言：人们对患有复杂心理健康（CMH）需求的人的体验知之甚少，包括那些被诊断为人格障碍（PD）的人和这些人的照顾者。对于那些在法医住院环境中的人来说，他们的照顾者可能有额外的需求，这一点鲜为人知。研究强调，社区照顾者支持服务被认为是不够的，而且异地安置被描述为给照顾亲人的能力增加了额外的压力。了解 PD 在患有 CMH 需求的人群中的情况，以及 PD 诊断如何影响护理和治疗体验，对于提供高质量的护理至关重要。
评估有 PD 诊断和异地安置经历的服务使用者和照顾者的护理体验。
对六名服务使用者和四名照顾者进行半结构式访谈，以探讨有 PD 诊断的人的体验和观点。访谈进行了录音，并进行了主题分析。
确定了四个相互关联的主题：PD 诊断对工作人员的影响、早期和适当的干预、对个人的认可以及 PD 患者的培训和知识。
针对工作人员的反污名干预措施、护理服务的研究以及包括对 PD 患者进行更多循证治疗的服务结构变化，可能有助于减少不同的治疗方法并改善康复预后。
本文从照顾者和服务使用者的角度为服务提供了改善护理的方法。应该采用更全面和较少医学化的方法来治疗与 PD 诊断相关的问题，并对所有医疗保健从业者进行 PD 培训，以改善患者的治疗效果。
