title: Mental health nurses' attitudes, behaviour, experience and knowledge regarding adults with a diagnosis of borderline personality disorder: systematic, integrative literature review.
abstract: OBJECTIVE
  To establish whether mental health nurses responses to people with borderline personality disorder are problematic and, if so, to inform solutions to support change.
  
  
  BACKGROUND
  There is some evidence that people diagnosed with borderline personality disorder are unpopular among mental health nurses who respond to them in ways which could be counter-therapeutic. Interventions to improve nurses' attitudes have had limited success.
  
  
  METHODS
  Systematic, integrative literature review.
  
  
  METHODS
  Computerised databases were searched from inception to April 2015 for papers describing primary research focused on mental health nurses' attitudes, behaviour, experience, and knowledge regarding adults diagnosed with borderline personality disorder. Analysis of qualitative studies employed metasynthesis; analysis of quantitative studies was informed by the theory of planned behaviour.
  
  
  RESULTS
  Forty studies were included. Only one used direct observation of clinical practice. Nurses' knowledge and experiences vary widely. They find the group very challenging to work with, report having many training needs, and, objectively, their attitudes are poorer than other professionals' and poorer than towards other diagnostic groups. Nurses say they need a coherent therapeutic framework to guide their practice, and their experience of caregiving seems improved where this exists.
  
  
  CONCLUSIONS
  Mental health nurses' responses to people with borderline personality disorder are sometimes counter-therapeutic. As interventions to change them have had limited success there is a need for fresh thinking. Observational research to better understand the link between attitudes and clinical practice is required. Evidence-based education about borderline personality disorder is necessary, but developing nurses to lead in the design, implementation and teaching of coherent therapeutic frameworks may have greater benefits.
  
  
  CONCLUSIONS
  There should be greater focus on development and implementation of a team-wide approach, with nurses as equal partners, when working with patients with borderline personality disorder.
authors.affiliation: Division of Mental Health Nursing and Counselling, Abertay University, Dundee, UK.|NHS Fife Research and Development Department, Queen Margaret Hospital, Dunfermline, UK.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Dickens
authors.affiliation: Division of Mental Health Nursing and Counselling, Abertay University, Dundee, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Lamont
authors.affiliation: NHS Fife Research and Development Department, Queen Margaret Hospital, Dunfermline, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gray
mesh_terms: D001291:Attitude of Health Personnel; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000451:nursing*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009740:Nursing Staff / Q000523:psychology*; D011568:Psychiatric Nursing
keywords: Mental health nurse; attitudes; borderline personality disorder; education; emotionally unstable personality disorder; experience; knowledge; systematic review