The Symptoms Of Borderline Personality Disorder Nursing Essay

‘Drawing upon an example of your leadership to date, critically analyse your role in tackling discrimination within your workplace.

Confidential statement: ‘no patient name or hospital name will be mentioned in this essay for confidential reason’.

INTRODUCTION

In this essay I will explore the meaning of discrimination and how the individuals or group of people with certain diagnosis especially in mental health are being discriminated against. I will also discuss the impacts discrimination can have on those service users and services provided. I will Lewins model of change and transformational theories (K344 block 2&3) to analyse and discuss my role in tackling discrimination in my place of work. And finally, I will evaluate the discussion and analysis and conclude by summarising how effective leadership can raise and improve clinical practice standard.

I work as a staff nurse in a psychiatric unit with 31 beds that provide care for various forms of mental illness for both males and females. I hold no managerial post or have any assigned leadership role. However as a qualified nurse I take charge of the shifts and have junior staff working with me. And being in charge of the shift I am responsible to make sure patients under my care receive best quality care by being a role model and lead by example.

The area of discrimination I identified that has impacted on my leadership role within the context of my place of work and my capacity was discrimination against group of people diagnosed with borderline personality disorder. Many people sees anyone with this diagnosis as attention seekers and not actually ill. This stereotypical idea has led to many ill patients that need help not receiving equal attention/care from health care staff; simply because of diagnosis given to them.

There was an example of such a case in recent past in my place of work; a young woman of 25 years was admitted with borderline personality disorder. She was well known to the service, she has been in and out of the hospital and the longest hospital stay was three weeks. Symptoms she usually presented with are self-harm thought and auditory hallucination which was telling her to self-harm though she has never acted on the ‘noises’ in her head after many years of complaints.

On this occasion she complained of the same symptom to a health care assistant, she stated that the voices were strong but the health care assistant dismissed it with wave of hand as ‘typical’ attention seeking behaviour, the qualify staff on duty was not informed. This service user managed to get hold of razor blades through another service user and slashed her breast very deep that flesh was dropping and bled heavily. She was discovered by another staff that was carrying out routine checks, timely intervention saved her life.

Discrimination can be defined as the unfair treatment of somebody which could be due to prejudice, stereotyping and passing of judgement. Discrimination can be for reasons ranges from race, ethnicity, gender and disability. Equality Act 2010 (DOH) defines a person as disabling if that person has a physical or mental impairment, and the impairment has a substantial and long term adverse effect on that person’s ability to carry out normal day to day activities, mental health is one of those classified as disability.

Discrimination can be described in two ways depending upon the condition in which it happens. It can be open that everyone can see and aware of what is happening, otherwise called overt discrimination and the opposite is the hidden one which is difficult to see which I can say discrimination as a result of stereotyping falls into. As defined above a source of discrimination could be stereotyping someone, which is creating ideas of characteristics of a person without even knowing him or her. This source of stereotyping could lead to treating someone unfairly and depriving them their rights.

Not just stereotyping, prejudice that is, being judgemental about someone when little is known about that individual, also involves making assumptions about a particular group of people. When this happens in health care institutions, it affects the quality of care patients receive or given out by the practitioners. The result of survey carried out in South Australia that compared the attitudes of 250 mental health staff and the public about the prognosis of people with schizophrenia and depression shows that the professionals were more pessimistic about the chances of recovery that the public (Graham T. et al, 2007).

The symptoms of Borderline personality disorder include unstable emotions, unstable interpersonal relationships, they also present with a need for intimacy and they fear rejection. Because of this people diagnosed with borderline personality disorder most often induce emotions in people around them. Derogatory terms such as ‘difficult’ demanding, treatment resistant and manipulative, attention seeking individual mostly used to describe people diagnosed with borderline personality disorder. This negative treatment and assumptions of these individuals may further lead to aggravating the self-harm or destructive behaviour.

It was stated (Wikipedia) that this stigmatization may be a reflection of the therapist’s own feeling about the patient, therefore diagnosis of borderline personality disorder says more about the clinician’s negative reaction to the patient than it does about the patient itself.

Graham T. et al (2007) in their article stated that some mental health issues are less favoured by psychiatric staff, most especially people with a diagnosis of ‘personality disorder’. Unexpectedly as indicated in the article that although patients with that diagnosis claims to be rejected by healthcare workers, there are few investigations of stigma against people with personality disorder. But some studies suggests that people with this diagnosis are felt by staff to be less deserving of care, attention-seeking, annoying, and in control of their suicidal urges. Therefore the diagnosis is interpreted by some psychiatric staff as mocking and one that does not to stimulate their compassion.

Also numbers of focus group in England asked service users about their experiences of stigma and about who should receive targeted educational sessions to reduce discrimination. The group most often mentioned by about two-thirds of service users was family doctors, school children and police and employers. The attitudes of psychiatric nurses and other staff were similar to those of doctors. (Quoted from; Discrimination in health care against people with mental illness-Graham et al 2007).

As already mentioned, discrimination often have negative effect on the victims, it can lead to low confidence and self-esteem, it makes people to think about their worth, low confidence in turn make people becomes vulnerable and isolation from society which reinforces feeling of exclusion and withdrawal from society, mood becomes low and depression could set in and self-harming as a reaction to the feelings of social exclusion.

People diagnosed with borderline personality disorder are among the most difficult sets of clients requiring high level of skills and practitioners involved in their care. Most of the psychiatric staff report dealing with borderline personality found them moderately to extremely difficult to work with, and more difficult than other groups of patients.

While some patients feel the diagnosis of borderline personality disorder is helpful and allows them to understand that they are not alone and can connect with others with the same diagnoses that have developed better coping techniques. Some other patient sees the term ‘Borderline personality disorder’ as a derogatory label instead of informative diagnosis. Most stated that they were concern that their self-destructive behaviour is incorrectly perceived as manipulative and the stigma attached to the problem limit their access to health care (Wikipedia).

UK government recognises the barriers and in the light of this they formulate strategy, ‘no health without mental health’ ( department of Health, 2011) the strategy made tackling stigma and discrimination and human rights as priorities to improve health care service and reduce stigma and discrimination. Equality act, 2010 establishes the responsibilities of organisations including NHS and all employers towards people with disabilities which include people with mental health problems. It is therefore a legal obligation to promote equably access to health care, it is equally morally expedient.

In nursing, leaders need to do everything to tackle any form of discrimination at all levels by actively ensuring equality of opportunity for patient and staff alike.

For the purpose of this essay, I will demonstrate my leadership role to tackle discrimination I identified in the example I gave at the beginning of this assignment.

Usually when a major incident like the example I gave happens, the staff on duty do debriefing to talk about the incident and the impact it has on both staff and service user; and to take any action deemed necessary on any issue identified. After few days of reflection about the incident, I was of the opinion that stereotype ideas contributed to action or inaction on that day. Even though the health care assistant involved might not mean to discriminate since it was a common attitude, I decided to start the process of changing the staff attitude towards people diagnosed with borderline personality disorder.

In an informal chart with some of the health care assistant I was working with about what they know about discrimination. As expected most response was that people can be discriminated against because of their colour, gender, age and sexual orientation. We also discussed about the meaning of stereotyping ideas and passing judgement without having facts at hand, all the discussion were held in a relaxed atmosphere without referring to anyone or a specific issue.

I searched internet and printed out information on borderline personality disorder which contains the possible cause(s), presentations and some reasons for their behaviour or presentations which in some times could led to self-harming or destructive behaviour. It was made available to everyone working on the unit, after few days the feedback I received was encouraging. Many realised that practitioner’s attitude and behaviour most of the time contributes to why patients do ‘act out’, clearly it was evident that lack of adequate information or knowledge in most of staff attitudes.

Obviously looking after people diagnosed with borderline personality disorder can be challenging and exhaustive, extra special training is needed by all frontline staff taking care of this group of patients; this was suggested to my line manager.

Meanwhile, having realised that formal special training was not feasible at the time, we agreed among ourselves to be spending 20-30 minutes at least twice a week to encourage ourselves on how best we can improve on the care we give to this group of patients based on the new information and knowledge we have shared. First we reinforced the knowledge that we have to be taken each patient as a unique person, and what we realised from this was that they all have some things in common. They all expressed feeling of loneliness, rejection and thought they were not getting enough help they require, realising this we started group therapy apart from individualised care, where each and every one shared their experiences and learnt different coping mechanisms. Staff also learnt that these patients are not as difficult and bad as everyone thought if staff can show love and understanding; and also to let the patients know that staff are for them and can be approached anytime they need help or to talk.

I don’t have the opportunity to work with all health care assistants but I typed and printed out and shared it with all other health care assistants, what we have learnt, the progress and noticeable improvement in interaction between staff and patients especially two female patients on the ward with diagnosis of borderline personality disorder. It took a while for some health care assistant that work different shifts to really understand or take to what our small group started. However, after sometime through interactions with healthcare assistants that started the programme, they acknowledge the importance and the need for change.

Analysing my leadership role, it fit well into Lewin’s model of change (K344 block 3) which is in three stages.

Unfreezing current behaviours-which is to make people aware of the need for changes, this was demonstrated I had informal chart with the health care assistants that I was working with about discrimination and that stereotyping ideas leads to discrimination. I gave out printed information about borderline personality disorder, through this they learnt that this set of patients’ presentation has always been misinterpreted and there has always being reasons for most of their behaviour.

This is followed by Change stage which is a change to a new behaviour by explaining what is required and with encouragement. I made them realised if we show more understanding, listen to them and show passion patients will feel sense of importance, and also feel empowered.

And the last stage which is Unfreezing, which is actions to sustain the changes, we decided to be spending 10-20 minutes about two times a week to support ourselves and they were also advised on continuing personal development.

My leadership approach as described above can be analysed with transformational theory of leadership. My vision was to change staff stereotype attitudes towards certain group of patient that resulted into those patients to receive less attention. I initially sold my vision to small group of health care assistant I was working with in an open and honest manner. I demonstrated my listening skill when I had a chart with them to assess the areas of need of staff and patients. I established the area of need staff which is more information about presentations of borderline personality disorder patients. I suggested websites where they can get more information about the diagnosis, though I printed out some information in addition, this is also a demonstration of empowerment and motivation.

Partnerships was forged between myself, patients and the other members of staff to improve care we give this was demonstrated with three way communication and willingness and interest shown by all which enhance team working and positive outcomes.

Conclusion

In this assignment I identified discrimination of patients diagnosed with borderline personality disorder in acute psychiatric unit to analyse my role in tackling discrimination in my work place.

I gave example of a young woman of 25 years with this diagnosis who seriously self-harm as a result of not being taken seriously when she complained of self harm thought and auditory hallucination as result of stereotypical ideas held about them by the health care practitioners.

I went further to define discrimination which can be hidden or overt, and discuss how prejudice and stereotype can lead to discrimination.

Various survey and studies confirmed pessimism among health care staff about chances of recovery of patients. To ensure patient rights and equal access to health, government enacted equality Act (2010) and strategy to tackle stigma and discrimination’ no health without mental health’ (DOH, 2011).

I analysed the steps I took to change staff attitude which fit well into Lewins model of change (K334, block 3). I made staff aware of the need for a change by having a chart with them and given information from internet (Unfreezing current behaviour). This is followed by explaining that understanding of patient by listening to them and show love and compassion patient will feel important and empowered. And to sustain the changes, I advised continuous personal development and also we decided to be spending 10-20 minutes twice a week to offer support to each other.

Transformational approach was demonstrated in my approach, I had a vision of improving standard of care by changing stereotyping attitudes of staff, and I formed partnerships with patients and staff. I listened to patients and provide information to improve staff knowledge and improve their skill.

However, I still feel I need to improve on my critical analysis, my time management needs improvement as well, though it is difficult with full term job and family of four children. I believe these affects my essay presentation.