Exploring the Experience of Dialectical Behaviour Therapists: Challenging Therapeutic Pessimism Related to Borderline Personality Disorder

The public mental health setting wherein clinicians work with clients diagnosed with borderline personality disorder (BPD) provides a continual challenge for clinicians. For many decades a pervasive therapeutic pessimism has surrounded any discussions of attempts to work with clients with BPD with this population being viewed as ‘too difficult’ and ‘impossible to work with’. This pessimism and the ensuing counter therapeutic responses have been well documented in the psychiatric literature. The development of treatments such as dialectical behaviour therapy (DBT), a cognitive-behavioural therapy, for BPD has provided a basis for therapy for which there is increasing evidence of successful outcomes. Despite this evidence, the pervasive pessimism has been slow to lift. A limited literature explores attempts to positively influence clinician responses to this clientele. Within the public mental health service in which this research is based, DBT is well-established as a therapeutic modality. In the course of providing training, consultation and supervision for parts of this service, anecdotal evidence emerged suggesting that the impact of practising as a DBT therapist was greater than anticipated and DBT may provide a tool for facilitating a positive change in clinician responses. Given that this perception is not described in the literature it was appropriate to begin research in this area employing a qualitative methodology. This research explored the experience and impact upon mental health clinicians in a public mental health service undertaking training in DBT and practicing as DBT therapists. In-depth, semi structured interviews were conducted in July 2005 with clinicians practising as DBT therapists. Data analysis revealed a marked shift in perspective from ‘management to treatment’. Participants described positive professional and personal impacts of training and practising as DBT therapists. An enhanced capacity for self-awareness and ‘living life to the full’ was described by a number of participants. This initial research suggests that the practice of DBT by clinicians can generate a positive shift in both personal and professional identities that translates into a more optimistic and humanistic approach to clients diagnosed with BPD. Such a change may represent a significant challenge to the prevailing mental health discourse and practic

Difficult and frustrating? Caring for those with chronic and complex conditions

Caring for people with chronic and complex health needs has become an ever-larger part of everyday nursing. The World Health Organization has identified common and preventable risk factors that are the primary cause of chronic illness worldwide—hypertension, tobacco use, hyperglycaemia, physical inactivity, and overweight or obesity. Nurses now need an expanded range of skills and expertise that will enable them to work effectively with people whose chronic and frequently complex health issues may be seen as difficult and challenging. This article invites you to think about your experiences of caring for people with chronic and complex conditions. Before you read any further, take a moment to think about your response to some initial questions. How would you describe your attempts to work with people with chronic and complex health needs? Do you find yourself struggling to understand when your patient doesn’t appear to be following professional health advice? What do you hear your colleagues say about chronic illness

Supporting the nationally mandated transition to competency-based nursing curricula in Egypt

Egypt has a substantive and rich history in nursing education with continuous evolution over many years. A government commitment to further enhance the capacity of the nursing workforce recently required all nursing curricula to be upgraded and presented in a competency-based format. In response to this directive, lead agencies in Egypt, including the Educational Development Fund and the Nursing Sector Group of the Supreme Council of Universities, have garnered internal and external nursing expertise to provide guidance in the curriculum reform process. The authors of this presentation are currently working in close partnership with several Egyptian nursing education providers supporting the transition to competency-based nursing education. Shifting from bio-medical style syllabi to competency-based curricula is a time intensive and multi-faceted process. Successful transition requires a base knowledge of the fundamentals of competency-based programme design and its associated pedagogies. An understanding of relevant definitions, curriculum development processes, mandatory curriculum inclusions, and assessment techniques are core requirements to the development processes. This presentation provides an oversight of these terminologies and processes. The presentation provides insights to policy makers and educators embarking on similar nursing curriculum reform and nursing workforce capacity development initiatives

A framework for cyclical nursing curriculum review across multi-site and multi-country campuses

Cyclical curriculum review and continuous course improvement is an unarguable measure of quality nursing education. Higher education and professional regulators across the Middle East and North Africa (MENA) and African (Afro) regions are increasingly mandating cyclical review within accreditation and programme approval standards. Many nursing education providers in the region operate multi-site and multi-country campuses. A key challenge is to ensure that programmes keep pace with international standards in nursing education, and, that inter-campus drift does not occur in programme content and quality. Cyclical review offers a process whereby programmes can be updated to current best practice and consistent cross-campus standards can be maintained. The review process described in this presentation arises from a Aga Khan University project designed to review the status of courses within its post registration RN to BScN programme. The University operates four direct delivery sites in Kenya, Tanzania, Uganda and Pakistan and provides mentoring support to programmes in Upper Egypt and Mozambique. The project sought to assess currency of course content and develop a nursing course review framework for use by any educational provider involved in multi-campus programme delivery. The approach engaged an expert review team including internal and globally sourced external experts. The team involved subject experts and curriculum development and pedagoloical experts. Key foci of the review framework are described including; expected student outcomes, learning objectives, content inclusions, assessment items, and, teaching/learning resources. The review framework is of practical use to other educators involved in the review of course modules across multi-campus, multi-state, multi-emirate and/or multi-country settings

Public health service options for affordable and accessible noncommunicable disease and related chronic disease prevention and management

Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of the solution and encouraged to innovate and deliver better and more affordable health care, particularly preventative primary health care services. This paper draws attention to a range of exemplars to encourage and stimulate readers to think beyond traditional models of primary health service delivery. Examples include nurse-led, allied health-led, and student-led clinics; student-assisted services; and community empowerment models. These are reported for the interest of policy makers and health service managers involved in preventative and primary health service redesign initiatives

Public health service options for affordable and accessible noncommunicable disease and related chronic disease prevention and management

Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of the solution and encouraged to innovate and deliver better and more affordable health care, particularly preventative primary health care services. This paper draws attention to a range of exemplars to encourage and stimulate readers to think beyond traditional models of primary health service delivery. Examples include nurse-led, allied health-led, and student-led clinics; student-assisted services; and community empowerment models. These are reported for the interest of policy makers and health service managers involved in preventative and primary health service redesign initiatives

A Pilot Study Exploring Nursing Knowledge of Depression and Suicidal Ideation in Kenya

Nurses play key roles in recognizing, diagnosing, managing, and referring persons with mental disorders. This cross-sectional study assessed mental health literacy (depression and suicidal ideation) among nurses in a private urban referral hospital in Kenya. Nurses read a vignette and answered questions regarding diagnosis, treatment/interventions, and related attitudes and beliefs. Thirty-seven nurses (12 males) completed the questionnaire. Three correctly identified the diagnosis and 23 identified depression only. Although 75% noted the symptoms were extremely distressing, fear, and stigma were common reactions. This highlights challenges in mental health promotion/prevention in Kenya, and suggests continuous nursing education and curriculum enhancement is needed

Qualitative Research: A pathway to gain an understanding of UAE mothers’ experiences and perceptions of managing a child newly diagnosed with Type 1 diabetes

A childhood diagnosis of Type 1 diabetes is a life changing event for both the child and his/her family. The impact is experienced strongly by mothers who most frequently fulfil the primary caregiver role for children12 yrs old and younger. Studies which have sought to understand mothers’ experiences and perceptions of managing a child newly diagnosed with Type 1 diabetes are mostly questionnaire-based and few, if any, explore the issues within the uniqueness of a Middle-Eastern context. The qualitative research methods described in this discussion have been designed to gain a better understanding of UAE mothers’ experience in managing a child newly diagnosed with Type 1 diabetes. The intended research will provide the health service entity with the opportunity to review existing services and further enhance the service and nursing care provided to this growing clientele group

The role and value of nurses in care provision: Views and expectations of Emirati Nationals in the western region of Abu Dhabi, United Arab Emirates

Background: Reliable health user information is needed to effectively organize nursing services and deliver quality patientcentered care. Nurse leaders of Al Gharbia Health Services (AGHS) noted that although budget data and general workforce information were readily available, detailed information about patient experiences, views, and expectations was lacking. Objective: This study aimed to obtain preliminary data regarding health and nursing service expectations of Emirati nationals in the remote western region of Abu Dhabi, United Arab Emirates (UAE). Methods: This study used qualitative descriptive methodology. Semi-structured interviews were conducted with a sample of Emirati families who had recently accessed AGHS. Interviews focused on service user understanding and expectations of the role of nurses, nursing services, and the health service overall. Results: Emirati nationals’ views and expectations regarding nurses’ role and function in the healthcare team were highlighted. Participants’ expectations and the attributes they valued were distributed across two distinct areas: clinical competence and the “softer” skills of compassion, caring, and respect. Conclusions: These findings facilitate understanding of the expectations of Emirati health service users. Importantly, the results counter regional perceptions of nursing under-valued as a servant role across the UAE and broader Gulf Cooperation Council region. The findings may inform a range of activities including: a large-scale survey regarding the views and expectations of Emirati health service users; pre-service nursing education and nursing in service development; and the recruitment of Emirati nationals to the nursing profession. Further investigation regarding perceptions and valuing of nursing within the Emirati community is warranted

Nurses transitioning to primary health care in Australia : a practice improvement initiative

Introduction: Current nursing programs provide little pre-registration information and clinical exposure to primary health care nursing practice. Newly graduated nurses and those transitioning to primary health care report disorientation and confusion. Limited knowledge about the ideal elements of a program to support transitioning nurses is an imperative to understand how best to support nurses during this period. The peak body for nurses in primary health care was funded to develop and implement a 1-year transition to practice improvement initiative for nurses in Australia about to be employed in or who are new to primary health care. This quality improvement evaluation study aimed to determine the impact of the transition program on participants’ nursing knowledge, skills, and confidence, and their overall satisfaction with the program. Methods: A mixed methods evaluation of the project utilized data from online pre- and post-participation surveys, mentor meetings, and field notes. Descriptive statistics and paired t-tests were employed for quantitative items. Free text and field notes were subject to broad thematic analysis. Findings from qualitative and quantitative data were triangulated. Results: Ninety-three nurse participants and 62 mentors were recruited. There were statistically significant differences between mean summed post-completion and pre-completion self-assessment rating scores for knowledge, skills, and confidence. Program elements were well received. The orientation workshop, mentoring, and education activities were identified as most influential in supporting transition. The self-assessment framework was identified as least influential. Conclusion: A 12-month transition program was effective in building the knowledge, skills, and confidence of participants to deliver comprehensive and effective nursing services. © The Author(s) 2023