Nurses' attitudes when working with clients exhibiting traits of borderline personality disorder within the mental health services

Abstract

BACKGROUND: Individuals with Borderline Personality Disorder often seek support from mental health services due to increased vulnerability to stress and difficulties in interpersonal relationships. Despite its prevalence within these services, numerous studies report that BPD remains one of the most stigmatized and negatively perceived mental health diagnosis in clinical settings. These negative attitudes are notably persistent among nursing staff. Nurses play a vital role in the care of individuals with BPD, providing psychoeducation, safety planning, support for treatment adherence, and emotional care. Therefore, when nurses hold negative attitudes, they may reinforce harmful stereotypes, creating barriers to care and weakening the therapeutic relationship, which will ultimately hinder the clients’ recovery process. AIM: This research study aims to evaluate and assess the current local situation in relation to nurses' attitudes towards clients with BPD within both community and in-patient national mental health services. OBJECTIVES: The study assessed how nurses’ demographic characteristics and level of exposure to individuals with BPD influences these reported attitudes. RESEARCH DESIGN AND METHOD: A descriptive cross-sectional quantitative research method was employed for this study. A validated data collection tool called the APDQ, and an additional self-developed 8-item demographic section were distributed across both in-patient and community adult mental health services to 370 nurses. This study yielded a 59.9% response rate, with 191 completed questionnaires returned. RESULTS: Findings revealed a combination of both positive and negative perceptions among nursing staff towards BPD clients. Positive attitudes were particularly evident in the Acceptance vs. Rejection, Security vs. Vulnerability and Purpose vs Futility dimensions of the APDQ, On the other hand, negative attitudes emerged in the Enjoyment vs. Loathing factor and the Enthusiasm vs. Exhaustion factor. No significant correlation was found between exposure and attitudes, implying that frequency of interaction alone does not shape perceptions. However, demographic factors such as age, nationality, and years of experience were significantly associated with overall attitude scores, while level of education variable showed statistical significance only within the Security vs. Vulnerability factor. CONCLUSION: This study provides a nuanced and local perspective on the attitudes of nurses within Malta’s adult MHS toward individuals with BPD. The study highlights the importance of safeguarding, developing, and enhancing professional attitudes through targeted education, ongoing CPD, and informed service development. Such efforts can contribute meaningfully to fostering a more compassionate, nonjudgmental, and non-discriminatory nursing approach to care, while also supporting nurses’ professional autonomy in working with individuals living with BPD.