Throughout university we’d been taught that patients with this diagnosis can exhibit “challenging” behaviour, that they can divide teams and we should reflect on how we feel to avoid burnout.
Although we spent a great deal of time analysing how best to nurse patients with a personality disorder (PD), this was approached in a clinical manner. We barely covered the reasons why someone might choose to behave in these ways and want to spend their time in hospital.
So, what is it about this diagnosis that worries nurses before they’ve even met the patient?
Although those with PD can often put a strain on nurse time, I don’t believe reluctance to engage is the result of laziness.
Nurses join the profession wanting to help people. But trying to care for someone who appears to be thwarting attempts to be helped can leave health professionals feeling hopeless. It can be difficult to empathise with someone whose behaviour doesn’t always appear to fit with what they are saying. And even harder to put yourself in someone’s shoes when they are doing everything they can to avoid discharge, a situation that can often come up when nursing this patient group.
Let’s face it, mental health wards are a far cry from the Hilton so why do they want to stay?
It can be easy to forget thatBPD is an illness in itself and the challenging behaviour that can come with it is a symptom, not a personal attack. Understanding this behaviour makes it easier to get a grip on what is actually happening.
In my experience, this is where compassion can often fall down.
And, in these situations, maintaining unconditional positive regard can be difficult.
I agree with the Willis Commission that nurse education is of a high standard, but I feel that training is focused solely on helping and supporting people who want to get better. Little time is spent exploring the reasons why someone might rely heavily on services, often without any apparent reason.
Learning why someone may want to stay in hospital and go to extremes to resist discharge may help nurses, particularly those newly qualified, to remain compassionate when faced with challenging behaviour.
For this reason, it is essential that education on personality disorders centres on the reasons behind the presentation, rather than simply how to manage challenging behaviour.
After all, not everyone can learn compassion, but everyone can learn understanding.