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Accessible Summary: What is known on the subject?: It is known that people with a diagnosis of borderline personality disorder often experience crises in their mental wellbeing.There is little evidence about the approaches of mental health nurses in community‐based crisis teams when working with people with a diagnosis of BPD. What the paper adds to the existing knowledge?: This paper highlights that limited resources, work‐patterns and issues of stigma present challenges to delivering recovery‐oriented care.The paper highlights that nurses typically try to navigate the challenges to continue to provide individualized care, though their self‐assessment is that this is with mixed success. What are the implications for practice?: The findings suggest that support is needed to develop brief interventions specific to teams working with people with a diagnosis of BPD who are at a point of crisis. Introduction: People with a diagnosis of borderline personality disorder (BPD) are often in contact with mental health services at a point of crisis, and in the UK, this includes Crisis Resolution Home Treatment teams (CRHTT). There is a drive for services to be recovery orientated; however, there is little evidence about the degree to which community services achieve this for people with a diagnosis of BPD when in crisis. Research Aim: To understand the perceptions held by CRHTT clinicians about their provision of recovery‐orientated acute care, for people with a diagnosis of BPD. Method: From a purposive sample of a single CRHTT, seven registered mental health nurses were interviewed and Braun and Clarke's thematic analysis framework was used to interpret the data. Results: Five themes emerged: person‐centred care; the timing is wrong; inconsistent staffing; the risks are too great; and BPD as a label. Discussion: The results demonstrate tensions between a drive to deliver person‐centred care and a range of challenges that inhibit this, with the possibility of reframing a recovery approach as "recovery‐ready". Implications for Practice: A whole‐system approach is required to enable a consistent recovery‐oriented approach, but research is also needed for brief interventions specific to this context. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Personal experiences of self-injury and staff reactions have been published., What this paper adds to existing knowledge? There is an absence of a detailed account of the interpersonal processes surrounding self-injury within a specific helping relationship., This paper is the first to explore the in-depth relationship between self-injury and shame., What are the implications for practice? This research identifies a cycle of shame in which people come to expect negative responses from others, which further reinforce their negative beliefs and supports a continuing cycle of harm., Mental Health Nurses may work with clients to understand the interpersonal processes and consequences of their self-injury in the helping relationship., Abstract Introduction Literature on self-injury has recognized the impact on the relationship between clients and staff. Rationale There is an absence of a detailed account of interpersonal processes surrounding self-injury. Aim A Bricolage qualitative research approach was carried out in the United Kingdom that explored the interpersonal processes surrounding self-injury. Method Three pairs of clients and staff were interviewed about an incident of self-injury. The interviews were thematically analysed and then synthesized producing a deeper exploration of the relationship between the client and staff. Findings An interpersonal trigger followed by anger and shame, resulted in self-injury to 'numb' these experiences. Discussion Self-injury is conceptualized as a safety behaviour to avoid shame and anger and then as a maintenance cycle that traps the client in a reinforcing and rejecting relationship. Staff interviewed were able to reflect with the clients and help them reframe these experiences. Implications for practice Mental Health Nurses can work with clients to understand their own interpersonal cycles of self-injury. They can then reflect on their own roles in this process and avoid reinforcing the clients' negative beliefs. What the study adds to international evidence This is the first international paper to explore the interconnection between the client and a professional helper in their lived experiences of self-injury. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: One‐to‐one observation uses continuous staff observation to safeguard patients judged likely to harm themselves or others.Policies increasingly mandate that staff engage therapeutically with patients during one‐to‐one observation. Yet not enough is known about factors facilitating or impeding such therapeutic engagement. What does this paper add to existing knowledge?: This study enriches existing literature on one‐to‐one observation through integrating the perspectives of staff of different levels of qualification, and patients of different diagnostic and risk profiles.Whilst previous research has highlighted the occurrence of counter‐therapeutic staff‐patient interactions, integration of patient and staff perspectives in the current study has demonstrated that patient and staff often attribute the causes differently, with each apportioning blame to the other, leading both parties to feel misunderstood, and staff lack confidence to overcome these challenges.A novel finding was that rapport‐building via simple demonstrations of compassion and conversations about everyday things, was viewed as an essential prerequisite to encouraging patients to open up about their experiences of emotional distress, whilst implementation of techniques drawn from psychological interventions was viewed as less important than staff's core relational skills. What are the implications for practice?: Therapeutic engagement during observation can enhance its risk management aims, providing thought is given to understanding and negotiating complex dynamics between staff and patients. Supervision for staff conducting observations should focus on building rapport in preference to emphasizing psychological intervention (e.g. DBT), and should enable staff to reflect on better understanding and managing their own emotions towards "hard‐to‐engage" patients. Introduction: Policies increasingly focus on staff‐patient interactions during one‐to‐one psychiatric nursing observations as an opportunity for therapeutic engagement – yet if and how this is feasible is unknown. Aim: This study aimed to integrate staff and patient perspectives to determine what factors facilitate or impede therapeutic engagement during one‐to‐one observation. Method: Thematic analysis of qualitative interviews with 31 psychiatric inpatient staff at different levels of seniority and 28 inpatients spanning a range of diagnoses and risk profiles. Results: Negative experiences of observation were characterized by a reciprocal dynamic where both patients and staff withdrew from interactions, having felt the other did not want to engage with them. Staff and patients agreed that these difficulties could be overcome when staff showed patients that they cared, gradually building trust through simple demonstrations of compassion and 'normalizing' conversation about everyday things. This approach helped patients to feel safe enough to open up about their distress, which in turn helped staff to better understand their experiences and work with them to find solutions. Implications for practice: Engagement during observation could be facilitated if staff receive more supervision in understanding difficult dynamics that impede rapport‐building and in managing their emotions towards patients they experience as "hard‐to‐engage". [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject? UK health policy is clear that researchers should involve the public throughout the research process., The public, including patients, carers and/or local citizens can bring a different and valuable perspective to the research process and improve the quality of research undertaken., Conducting health research is demanding with tight deadlines and scarce resources. This can make involving the public in research very challenging., What this paper adds to existing knowledge? This is the first time the attitudes of researchers working in mental health and learning disability services towards PPI have been investigated., The principles of service user involvement in mental health and learning disability services may support PPI in research as a tool of collaboration and empowerment., This article extends our understanding of the cultural and attitudinal barriers to implementing PPI guidelines in mental health and learning disability services., What are the implications for practice? Researchers in mental health and learning disability services need to champion, share and publish effective involvement work., Structural barriers to PPI work should be addressed locally and successful strategies shared nationally and internationally., Where PPI guidelines are being developed, attention needs to be paid to cultural factors in the research community to win 'hearts and minds' and support the effective integration of PPI across the whole research process., Abstract Introduction Patient and public involvement ( PPI) is integral to UK health research guidance; however, implementation is inconsistent. There is little research into the attitudes of NHS health researchers towards PPI. Aim This study explored the attitude of researchers working in mental health and learning disability services in the UK towards PPI in health research. Method Using a qualitative methodology, semi-structured interviews were conducted with a purposive sample of eight researchers. A framework approach was used in the analysis to generate themes and core concepts. Results Participants valued the perspective PPI could bring to research, but frustration with tokenistic approaches to involvement work was also evident. Some cultural and attitudinal barriers to integrating PPI across the whole research process were identified. Discussion Despite clear guidelines and established service user involvement, challenges still exist in the integration of PPI in mental health and learning disability research in the UK. Implications for practice Guidelines on PPI may not be enough to prompt changes in research practice. Leaders and researchers need to support attitudinal and cultural changes where required, to ensure the full potential of PPI in mental health and learning disability services research is realized. Relevance statement Findings suggest that despite clear guidelines and a history of service user involvement, there are still challenges to the integration of PPI in mental health and learning disability research in the UK. For countries where PPI guidelines are being developed, attention needs to be paid to cultural factors in the research community to win 'hearts and minds' and support the effective integration of PPI across the whole research process. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? 'Expertise by experience' has become an increasingly valued element of service design and delivery by mental health service providers., The extent and influence of mental health professionals' personal experience of mental ill health on clinical practice has seldom been interrogated in depth., What this paper adds to existing knowledge? We investigate how mental health nurses' own personal experience of mental ill health informs their mental health nursing practice with particular reference to direct work with service users., Participants said that personal experience could impact on work in three positive ways: to develop their relationship with service users, to enhance their understanding of service users and as a motivation for potential mental health nurses to join the profession., This study moves the discussion of the state of mental health nurses' mental health further towards the recovery and well-being focus of contemporary mental health care, where 'expertise by experience' is highly valued., What are the implications for practice? We must address the taboo of disclosure within clinical nursing practice and debate the extent to which personal and professional boundaries are negotiated during clinical encounters., Abstract Introduction 'Expertise by experience' is a highly valued element of service delivery in recovery-oriented mental health care, but is unacknowledged within the mental health nursing literature. Aim To explore the extent and influence of mental health professionals' personal experience of mental ill health on clinical practice. Method Twenty-seven mental health nurses with their own personal experience of mental ill health were interviewed about how their personal experience informed their mental health nursing practice, as part of a sequential mixed methods study. Results The influence of personal experience in nursing work was threefold: first, through overt disclosure; second, through the 'use of the self as a tool'; and third, through the formation of professional nursing identity. Discussion Mental health nurses' experience of mental illness was contextualized by other life experiences and by particular therapeutic relationships and clinical settings. In previous empirical studies, nurses have cited personal experience of mental illness as a motivator and an aspect of their identity. In this study, there was also an association between personal experience and enhanced nursing expertise. Implications for practice If drawing on personal experience is commonplace, then we must address the taboo of disclosure and debate the extent to which personal and professional boundaries are negotiated during clinical encounters. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Learning disability nursing in the area of people with a learning disability and an offending background has developed considerably over recent years, particularly since the publication of the Bradley ()., There has been limited work into the competencies nurses require to work in this area, and even less about the personal attributes of learning disability nurses., What this paper adds to existing knowledge? Learning disability nursing's specific contribution to the care of this population lies in their knowledge of the interaction between the learning disability, an individual's, sometimes abusive, personal history and an understanding of the subsequent offending behaviour., The knowledge base of nurses working with people with learning disabilities and an offending background needs to reflect the changing service user group. This is particularly in relation to substance misuse, borderline personality disorder, and mental health and the way such factors inter-relate with the learning disability., What are the implications for practice? Further research is required into the relationship among decision making, risk taking or reluctance to do this, and the personal attributes required by nurses to work in secure learning disability care., Learning disability secure services are likely to continue to undergo change as circumstances alter and the offending population demonstrate greater complexity; nursing competencies and personal attributes need similarly to adapt to such changes., Mental health nursing has a great deal to contribute to effective working with this population, specifically with regard to developing strong relationships when concerns around borderline personality disorder or substance misuse are particularly in evidence., Abstract Aim To identify and discuss the personal attributes required by learning disability nurses to work effectively with people with an offending background in secure and community settings. Background This study was part of a larger research investigation into the nursing competencies required to work with people with an offending background. There are few existing studies examining the personal attributes necessary for working with this group. Design A qualitative study addressing the perceptions of nurses around the personal attributes required to work with people with learning disabilities and an offending background. Methods A semi-structured interview schedule was devised and constructed, and 39 individual interviews were subsequently undertaken with learning disability nurses working in high, medium, low secure and community settings. Data were collected over 1 year in 2010/11 and analysed using a structured thematic analysis supported by the software package MAXqda. Findings The thematic analysis produced three categories of personal attributes, named as looking deeper, achieving balance and connecting, each of which contained a further three sub-categories. Conclusion Nursing of those with a learning disability and an offending background continues to develop. The interplay among personal history, additional background factors, nurses' personal attributes and learning disability is critical for effective relationship building. [ABSTRACT FROM AUTHOR]

Across the UK, mental health professionals are strongly objecting to threats to their roles. Against this background we use ethnographic data from a study of roles and responsibilities in community care, undertaken across two contrasting sites in Wales, to demonstrate how work is sensitive to local organizational features and to show how gaps can grow between the public claims professions make about their contributions and the actual roles which their members fulfil in the workplace. We reveal how, in one of our two research sites, immediate contextual features shaped the work of nurses and social workers towards the fulfilment of expanded packages of activity. We then show how subsequent policy (including 'new ways of working'), combined with new pressures arising from the economic downturn, carry the potential to accelerate the wider creation of workplaces of this type. We examine some implications of these processes for nurses and others, and for the system of mental health care as a whole, and conclude with a call for closer attention to be paid to the potential, wider, impact of current developments. [ABSTRACT FROM AUTHOR]

Introduction: Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of service users or staff views on working with women in secure care. Aim: This qualitative study, embedded in a multimethod evaluation of WEMSS, aimed to explore the views and experiences of staff in WEMSS and comparator medium secure services. Methods: Qualitative interviews took place with nine WEMSS staff and nine comparator medium secure staff. Interviews focused on factors important for recovery, barriers to facilitating recovery and operational aspects of the service. Discussion: This study provides a rare insight into the perspectives of staff working in UK women's secure services, an under-researched area in the UK and internationally. Findings suggest that the success of services, including WEMSS, is compromised by operational factors such as the use of bank staff. Implications for practice: Comprehensive training and supervision should be mandatory for all staff, so best practice is met and staff adequately supported. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject Intimate partner violence (IPV) impacts significantly on the lives and health of those who experience abuse, The impact of IPV exerts a detrimental impact on mental health as well as physical health, but this is often not recognized by professionals, What the study adds to existing knowledge This study highlights the impact of IPV on the lives and health of older women from the perspective of older women themselves, The approach taken to the study illuminates the ways in which older women describe their experiences within the broader narratives of their experiences, This study has explored the particular situation for older women as told through creative expression and their own stories of survivorship., Implications for practice Nurses and other healthcare professionals need to be aware of the enduring impact of IPV for older women, particularly within the context of mental health, Those working with older women also need to be alert to the potential barriers to disclosure and disjuncture between professional dialogue and personal narrative, Abstract Introduction Intimate partner violence ( IPV) exerts a detrimental impact on the lives and health of all who experience abuse. This includes both physical and mental health and well-being. The experiences of older women however may be different, and these differences may not be recognized or accounted for within existing care provision. Aim To explore the impact of IPV on the lives and health of older women told from the particular perspective of older women themselves as these accounts are largely absence from existing IPV discourse. Method An arts-based research approach with five older women survivors of IPV through the codevelopment and organization of an arts-based workshop. The workshop essentially encompassed four main arts strands and included the creation of clay models and poetry. Findings The findings of the study highlight the significant impact of IPV on the lives, mental health and well-being of older women. This included feelings of social isolation, inability to trust others and a loss of self-identity. Discussion Intimate partner violence is a global issue and as such of relevance for those working in healthcare contexts beyond the UK. While there is a growing body of evidence surrounding IPV and older women, this has largely been presented through researcher-led accounts and as such the narratives of women themselves may not have been adequately acknowledged. Unlike much of the existing evidence, this study has explored the particular situation for older women as told through creative expression and their own stories of survivorship. In this study, the fluidity of the potential materials available in the workshops meant that both the representations through which the women spoke and the primacy of their voices, over those of more traditional researcher accounts, were in evidence throughout. Implications for Practice Mental health nurses and practitioners are often on the front line for care and support for older client populations. IPV across the life span is a global issue for healthcare practitioners. It is anticipated that the findings of this study will provide the mechanism through which mental health nurses and other practitioners may reflect on older women's accounts of IPV as told by older women in this study in their own words. Reframing from dominant professional discourse to personal narrative is central to person-centred approaches and is central to contemporary practice. Ultimately, this has the potential to improve the effectiveness of care provision and support. Relevance to Mental Health Nursing The findings presented in this study have the potential to provide a powerful tool for those working within mental health contexts and healthcare professionals working with older populations more generally to consider both the hidden nature of IPV and the ways in which IPV can significantly impact on mental health and well-being in later life. [ABSTRACT FROM AUTHOR]

Accessible summary People diagnosed with borderline personality disorder (BPD) can raise anxiety in health professionals and constitute a high proportion of psychiatric inpatients in generic settings., Mentalization-based therapy (MBT) is an evidence-based psychological treatment effective in the treatment of people diagnosed with BPD, but this has been used and evaluated only in specialist settings., Mentalization-based treatment skills training (MBT-S) is a new and compact 2-day workshop which aims to provide mental health professionals with MBT skills for use in generic health-care settings and has never been evaluated., This study assesses staff nurse perceptions of the impact of MBT-S on their practice when working with people with a diagnosis of BPD in the generalist setting of acute mental health wards., Staff nurses perceived MBT-S as a straightforward but empowering skill set which also contributed to attitudinal change to people diagnosed with BPD. MBT-S promoted empathy as a response to instances of self-harm which removes the potential of a vicious cycle of iatrogenic harm., Staff found MBT-S to be flexible in its structured or 'off the cuff' usability, a desirable attribute in acute mental health where people diagnosed with BPD primarily present in crisis and not for long-term structured treatment., Abstract People diagnosed with borderline personality disorder ( BPD) are highly prevalent in acute mental health wards, with staff nurses identifying a challenge in working with people who can be significantly distressed. This has contributed to a negative stereotype verging on stigmatization. Mentalization-based therapy ( MBT) is a psychological therapy which has been shown to be of benefit to people with a diagnosis of BPD, yet it has been utilized and evaluated only in partial hospitalization and outpatient settings. Despite this, most people diagnosed with BPD will continue to be treated in generic inpatient settings such as acute mental health. Mentalization-based therapy skills training ( MBT- S) is a new and cost-effective 2-day workshop aiming to provide generalist practitioners with MBT skills for use in generic settings. This study aimed to capture staff perceptions of the impact of MBT- S on their practice when working with people with a diagnosis of BPD in acute mental health. Through two focus groups, this study assessed the perceptions of nine staff nurses. An interpretive phenomenological approach was utilized in data analysis. Participants found the approach easy to grasp, improving of consistency between staff and flexible in its use in planned or 'off the cuff' discussions. MBT- S promoted empathy and humane responses to self-harm, impacted on participants ability to tolerate risk and went some way to turning the negative perception of BPD through changing the notion of patients as 'deliberately difficult'. Staff felt empowered and more confident in working with people with a diagnosis of BPD. The positive implication for practice was the ease in which the approach was adopted and participants perception of MBT- S as an empowering skill set which also contributed to attitudinal change. In acute mental health environments, which may not have the resources to provide long-term structured treatments to patients, MBT- S could be viewed as ideal as participants applauded its flexibility. The promotion of empathy also sees a move away from iatrogenic damage caused by unhelpful responses to self-harm. In the context of wider research, this study shows that staff nurses find the MBT- S skill set valuable in the generic inpatient setting of acute mental health. [ABSTRACT FROM AUTHOR]

Accessible summary This study investigated the perspectives of mental health nurses working in a medium secure unit, regarding the impact of the security procedures used to manage patient substance misuse on nurse-patient relationships., Data from the interviews were analysed and revealed that the participants perceived that the intrusive nature of the procedures was detrimental to their relationship with patients. Both the relative degree of intrusion posed by the procedure, and the communication skills of nurses were important factors in determining the extent and duration of negative effects on relationships., A number of recommendations were made to improve policy and practice in relation to the application of the procedures. Firstly, that the use of partial strip searching should be minimized. Secondly, that unit managers should ensure consistent application of urine drug screening policies and that responsibility for undertaking the procedures should be spread evenly throughout nursing teams to avoid patients 'splitting' teams into 'good' and 'bad' nurses; Finally, that staff should receive further training in both substance misuse and communication skills., Abstract The role conflict experienced by forensic psychiatric nurses between their therapeutic responsibilities and their responsibility to operationalize security procedures is well established in the literature. There has been less investigation into how this role conflict is played out specifically in the management of inpatient substance misuse in forensic units. This study, therefore, aimed to explore the views of nurses working in one medium secure unit of the impact of the procedures used to manage substance misuse (partial strip searching, room searching, canine searching, 'pat' (or 'rubdown') searching, urine drug screening) on their relationships with patients. Ten interviews of registered mental health nurses working in a medium secure unit in the Northwest were carried out. The interview data were transcribed verbatim and framework analysis used to identify emergent themes. The impact of the procedures on nurse-patient relationships was reported as largely negative by the participants. They reported that the intrusion of the procedures had a detrimental effect on their relationships with patients. The relative degree of intrusion posed by each of the procedures was an important factor in determining the extent and duration of damage to nurse-patient relationships, as was the communication skills of the nurse conducting the procedure. [ABSTRACT FROM AUTHOR]