Addressing attitudes of pre registration mental health nurses towards people with Personality...

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  • Slide 1
  • Addressing attitudes of pre registration mental health nurses towards people with Personality disorder (PD): evaluation of an educational programme Lynda Smithies Professional Lead School of Nursing and Midwifery, Keele University UK
  • Slide 2
  • Introduction Negativity surrounding personality disorder NIHME (2003) PD No Longer a Diagnosis of Exclusion NIHME(2003a) The Personality Disorder Capabilities Framework -Breaking the Cycle of Rejection 2007 DH/Ministry Justice commissioned the Knowledge and Understanding Framework (KUF)
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  • Goal of K.U.F. To improve service user experience through developing the capabilities, skills and knowledge of the workforce in health, social care and criminal justice settings. Develop a realistic culture of hope and respect 3 levels
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  • KUF (level 1) 3 facilitated study days Facilitated jointly by practitioner and service user High quality on line learning materials
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  • Setting The study took place in a School of Nursing and Midwifery in a University the UK in 2013/2014
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  • Aim To examine the understanding,attitudes and capabilities of 3 cohorts of mental health pre registration student nurses towards people with PD,immediately before and after a three day programme (KUF).
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  • Sample Nursing students (BSc(Hons) and DipHe) were in their second year of a three year programme leading to registration. All students in three consecutive cohorts consented to take part in the study(n=54). Students who did not complete all three days were excluded from the study (n=10)
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  • Data collection Data was collected by pre and post training questionnaires using PD-KASQ (Bolton et al 2010). *Knowledge and understanding *Attitudes *Capabilities Also captured were students anonymous comments about the perceived benefits of the programme.
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  • Results :Qualitative 1. What is the one thing that you have learned that will influence your daily work Hope, optimism and recovery Challenging stigma Developing skills to work with this client group
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  • Hope,Optimism & Recovery we should encourage recovery and help them believe that it is possible, also being aware of how my behaviour etc. at work can affect patients (student 106) That PD is not something to be shied away from and there is chance of recovery and for the sufferer to be able to be a valued member of society (student 03)
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  • Challenging stigma Not to be afraid to challenge negative attitudes to PD from other professionals (student 25) I have learnt not to listen to other peoples negative perceptions, and to be more understanding of people with personality disorder (student101) Challenge stigma within teams & not let poor staff attitude influence my way of working (student 120 )
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  • Developing skills I began the training thinking I would learn how to deal with people with personality disorders. I actually learnt about myself how my actions will impact on the relationships I have with clients.I realised the value of supervision when working with a difficult client group.I had previously thought of supervision as optional,now I realise it is imperative (student 103) I feel I will have more understanding on PD and I will be more open minded.I have a lot more patience with PD and feel a lot more confidence in the diagnosis (student 116) That there is more to a persons behaviour than what is on the surface. Its important to spend time with them to understand the root cause rather than dismissing the behaviour as disruptive (student 107)
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  • NICE (2009) 1.1.4.1 When working with people with borderline personality disorder: explore treatment options in an atmosphere of hope and optimism, explaining that recovery is possible and attainable build a trusting relationship, work in an open, engaging and non-judgemental manner, and be consistent and reliable bear in mind when providing services that many people will have experienced rejection, abuse and trauma, and encountered stigma often associated with self-harm and borderline personality disorder.
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  • 2. Any other comments ? Positive learning experience Programme should be mandatory Service user as facilitator
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  • Positive learning experience Fantastic and informative (Student 117) Having worked with people with PD previously I didnt think I would learn much,I was so wrong.I feel confident following my training & teaching (student 103 ) Very good,I enjoyed the variation between the distance learning at home and the classroom based learning (student 19) I have found the course extremely useful and informative.Thank you (student 7 )
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  • Mandatory All health care professionals should receive this training (student 120) Very insightful. I think this training should be mandatory for mental health professionals (student 116) This training should be provided for all students,not just MH (student 2)
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  • Service user as facilitator I found having a survivor of PD a good insight to the disorder and it makes you understand someones experiences of the service provided (student 21) It was a positive learning experience and found J* a joy to learn from (student 19) I really thought the combination of trainers /service users and 1 lecturer worked really well (student 112) Really enjoyed the training and found it very informative having a service user teaching the training is fantastic and makes it more interesting as they have first-hand experience (student 106) very good that we get to listen to a person who has a diagnosis of PD and understand it from their view (student 119)
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  • Strongly disagree Disagree Uncertain Agree Strongly agree 1. I feel that I have a good knowledge of the diagnosis of personality disorder.12345 2. I feel that I do not have enough knowledge about the nature and clinical characteristics of this client group.12345 3. I feel that I have a good understanding of how clients may develop a personality disorder.12345 4. I feel that I have a good understanding of why clients harm themselves or behave in self-destructive ways.12345 5. I have a good understanding of psychological models of personality disorder12345 6. I feel that I do not have the necessary clinical skills to work with this client group. 12345 7. I feel confident that I can make a positive impact on the care of this client group.12345 8. I feel able to apply psychological models in my work12345 9. I feel understanding towards PD clients12345 10. I feel interested in PD clients12345 11. I feel able to help PD Clients12345 12. I feel pessimistic about PD clients12345 13. I feel frustrated with PD clients12345 14. I feel that clients with this diagnosis often engage in self-harming behaviour as a way of manipulating other people. 12345 15. I often feel overwhelmed by the problems that clients with personality disorder have12345 16. I often feel that there must be something more that I could do to help clients with personality disorder12345
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  • Results Statistically significant increase in all mean scores pre to post in Knowledge and understanding * Attitudes Capabilities
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  • Q.5.I have a good understanding of psychological models of personality disorder Pre mean (disagree) Post mean (agree ) ChangeSignificance (p - value) 2.194.07+ 1.880.00
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  • Q.5.I have a good understanding of psychological models of personality disorder Pre mean (disagree) Post mean (agree ) ChangeSignificance (p - value) 2.194.07+ 1.880.00
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  • Q.2:I feel I do not have enough knowledge about the nature and clinical characteristics of this group Pre mean (agree) Post mean (disagree ) ChangeSignificance (p- value) 3.672.21 - 1.460.00
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  • Q1:I feel I have a good knowledge of the diagnosis of personality disorder Pre mean (uncertain) Post mean (agree) ChangeSignificance (p-value) 2.884.27 +1.390.00
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  • Q14:I feel that clients with this diagnosis often engage in self harming behaviour as a way of manipulating other people Pre mean (uncertain) Post mean (disagree) ChangeSignificance (p-value) 2.881.76 -1.120.00
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  • Q13.I feel frustrated with PD clients Pre mean (disagree/unceratin ) Post mean (strongly disagree/disagree ) ChangeSignificance (p-value) 2.241.69 -0.550.00
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  • Findings :after the programme Pre registration mental health nurses showed statistically significantly more positive attitudes to people diagnosed with Personality Disorder They identified a statistically significant improvement in their knowledge of Personality Disorder They statistically significantly improved their understanding of client behaviour and psychological models of care. They felt statistically significantly more confident that they could make a positive impact in the care of people with Personality Disorder
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  • Strengths and weaknesses Sample :small /nursing students Change in practice ? No follow up Findings supported by other studies (Davies et al (2014),Krawitz (2004))
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  • Service user as co facilitator Effective and successful Gains for students,practitioner /lecturer,service user Culture that