Personality Disorder Diagnosis: Personal Experience

People with a personality disorder diagnosis are generally considered particularly difficult to manage, treat, and interact with; they are often disliked by healthcare professionals; and are widely believed to have a negative impact on staff working with them (Freestone et al,2015). Professionals can also have an impact on service users and this contributes to the nature of the environment which they are working in. I will be reflecting on how staff and patients influence each other both positively and negatively within this ward environment. The model I will be using is Borton's reflective model (1970), which consists of the subheading what, So what and Now what.

During one of my shifts, I had handover as usual and was observing the interaction between staff and patients. It was a very demanding day from the patients and this gave me insight to how the ward can be. I was not prepared mentally for such an experience. I found that some staff members were feeding into how the patients were behaving and if this was my first day I would not have been able to differentiate who was a patient and who was a staff member. The shift became heavy and upsetting for me however I was very conscious of not allowing my feelings to show. I found it difficult to overcome my fear of interacting with some of the patients who were demanding of staff.

So, what?

After a discussion with my mentor, I decided to research on how staff are affected by working alongside individuals with personality disorder. According to Moore (2012) and Adshead (2002) stated that working with patients with personality disorder is understood to be challenging and emotionally demanding and can evoke feelings of helplessness, therapeutic failure and anger in staff and desires to maintain social distance. These challenges may arguably be amplified within secures setting where patients may present as both ‘distressed and highly distressing in the actions they undertake’ and staff are required to manage both the risk and the vulnerability of patients.

Negative attitudes contribute to a sense of stigma, which can have impact on therapeutic relationships with patients, as well as hindering any management efforts and negatively impacting on clinical outcomes. The negative attitudes held by staff can also influence the likelihood of patients seeking help or assistance regarding their care. Positive attitudes result in positive outcomes in terms health, motivation, low sickness rates and low staff burnout (Bowers et al,2003)

Another topic I researched was transference between staff and patients. Transference is a situation where feelings, desires and expectation are redirected or applied to another person. This was something to consider especially when working with people who have a diagnosis of personality disorder. It is something that is unconsciously done however it has an impact on the delivery of care. Transference is something that needs to be effectively managed by maintaining and paying attention to boundaries.

Recognising a possibility of transference, counter‐transference along with repetitive patterns of behaviours is vital in ensuring nurses can effectively address any rising situations by responding thoughtfully and appropriately.

The final topic is staff burnout. Burke (1981) states that “Under stressful working conditions, professionals using poor coping strategies may become disenchanted, discouraged, irritated, frustrated, and confused, resulting in poor job performance,” this highlight the severity of burnout.

Other factors that contribute to burnout is working long shift, long hours contribute to fatigue. The environment which we work in can be fast paced and busy. In addition, the responsibility nurses and health professionals have has increased over the past couple of years due to advancements in technology and documentation. The extensive workload can cause nurses to feel overwhelmed or experience a loss of control. Shortage of staff creates as busier, more hectic days for nurses. The fast-paced workload can cause nurses to feel overwhelmed and stressed. Over time, this stress can lead to nursing burnout.

According to Young (2009), he states that “…the effective helper has good self-care skills.” Many people who work within the profession want to help others, but soon find that to do so they must make certain that they have something to give. It is easy to become emotionally ‘bankrupt’ and ‘burned out’ if one does not develop techniques for stress management, time management, relaxation, leisure, and personal renewal.

Now what.

In my training I have learnt that it is important to look after your own wellbeing and there needs to be a balance when working in such settings. It is important to effectively manage your time and seek peer support when feeling overwhelmed. It is important to step away from the situation if needed and reflect on what has occurred. Transference is unconsciously done however it can have a negative impact on your working life and this is something I have realised that it is vital to recognise when it is happening and when to seek help from fellow colleagues to prevent possible burn out.