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Research: Thematic Analysis of staff views of guidance for working with
borderline personality disorder in crisis and suicide prevention training.
Kate Sloan
Nurse Practitioner in PsychotherapyScottish Personality Disorder Network
Thematic analysis of staff views
Crisis presentations of patients with a diagnosis of borderline
personality disorder
Seeking help at points of emotional distress
They in be seeking hospital admission
At this point of crisis staff have to assess risk and act accordingly
holding in mind the patient, systems we work within and more
recently hold in mind how we influence HEAT targets
Guidance NICE 2009
Maintain a calm and non-threatening
attitude
Use empathy and open ended questions
including validating statements to identify
the onset and course of the current
problems
Seek to stimulate reflection about solutions
Avoid minimising the persons stated reason
for the crisis
Refrain from offering solutions before
receiving full clarification of the problems
Seek alternatives to admission
STORM-Suicide Prevention Training
Assessment WorksheetCrisis Management Worksheet
Problem solving WorksheetCrisis Preventions Worksheet
Rational outline
Patients experience high levels of distress resulting in seeking help as
a result of self harm or when experiencing suicidality thoughts
Patients may seek hospital admission to gain relief from distress which
has created debate and controversy about its efficacy
The prevalence within mental health population is reported at 50% not
including co-morbid diagnosis
In Scotland the ISD suggest recurrent admissions with a personality
disorder diagnosis is 24.5%
Local IHTT services have 14% with a diagnosis of EUPD
research questions
What are the views of mental health practitioners who work within
secondary care services that respond to crisis presentations, on
both the practice guidelines and suicide prevention training
outlined within the literature for patients diagnosed with EUPD
What other interventions are utilised by mental health practitioners
that are not included within the data collection tool and the rational
for the interventions
Does the guidelines within the literature support practitioners
when seeking alternatives to admission
How do the guidelines and training inform local practice guidelines
Methodology
Qualitative- understanding the views and perceptions of the subjects
Subject group - mental health staff who have to respond to crisis
Data collection - focus group, capture the context engage a discussion
Data collection tool - created a series of questions based on guidance
and training
Ethics - Sensitive clinical issue
Data analysis - thematic analysis
Reliability and validity
Reduce bias - how subjects are recruited, who facilitates the group, who
transcribes
Transparency - how data is managed
Reduce researcher influence
The results
Prevention of crisis
The organisations role in managing crisis
Maintaining the therapeutic alliance
Managing risk of suicide - practitioners anxiety
Prevention of crisis
Prevention
Organisational systems adverse to therapeutic
care
Providing a consistent therapeutic experience
Early interventio
n
Organisation
Organisation role in managing
crisis
Problems within the
system
Do we have the
resources
Maintaining the therapeutic
alliance
Therapeutic ruptures
Development of knowledge and
skills
Management of risk- practitioner anxiety
Stopping suicide
Doing the right thing
Collaborative joint crisis management plans Moran et al , 2010
Evidence based treatments
Structured clinical management
Theoretically informed model for daily clinical practice
Agreed local guidance
Access to specialist treatments
Strengths and limitations
Did gather view and perspectives
Not generalisable
Fewer numbers than desired
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