Mixed‐methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder

Dickens, Geoffrey, Lamont, Emma, Mullen, Jo, MacArthur, Nadine and Stirling, Fiona J. (2019) Mixed‐methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder. Journal of Clinical Nursing, 28 (13-14). pp. 2613-2623. ISSN 0962-1067

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Abstract

Aims and objectives: To evaluate and explore mental health nurses’ responses to and experience of an educational intervention to improve attitudes towards people with a diagnosis of borderline personality disorder (BPD). Report findings are concordant with relevant EQUATOR guidelines (STROBE and COREQ).

Background: Attitudes towards people with a diagnosis of BPD are poorer than for people with other diagnoses. There is limited evidence about what might improve this situation. One intervention with reportedly good effect uses an underlying biosocial model of BPD. No previous intervention has been co-produced with an expert by experience. We developed and delivered a 1-day intervention comprising these elements.

Design: A mixed-methods design was used comprising prospective within-subjects cohort intervention and qualitative elements. Participants were mental health nursing staff working in inpatient and community settings in one NHS Board in Scotland, UK.

Methods: Measurement of cognitive and emotional attitudes to people with a diagnosis of BPD at pre- and postintervention (N = 28) and at 4-month follow-up. Focus groups were used to explore participants’ experiences of the intervention (N = 11).

Results: Quantitative evaluation revealed some sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies and negative attitudes in general. Qualitative findings revealed some hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert by experience.

Conclusions: Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. Participants provided contrasting messages about what they think will be useful. Relevance to clinical practice: The study provides further evidence for incorporation of a biosocial model into staff training as well as the benefits of expert by experience co-production. Mental health nurses, however, believe that more well-resourced services are the key to improving care.

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