Psychiatric nurses’ knowledge, experience and attitudes towards clients with borderline personality disorder P. D. JAMES 1 ms c bs c( h ons) d ip n d ip rebt rpn & S. COWMAN 2 p h d ms c ffnmrcsi pgc ert e d, ( a dults) d ip n ( l ondon) rnt rgn rpn 1 Post Grad Student, Royal College of Surgeons in Ireland, Clinical Nurse Specialist, Youth Drug & Alcohol Service (YoDA), Tallaght, Dublin, and 2 Head of Department, Royal College of Surgeons in Ireland, St Stephens Green, Dublin, Ireland JAMES P. D. & COWMAN S. (2007) Journal of Psychiatric and Mental Health Nursing 14, 670–678 Psychiatric nurses’ knowledge, experience and attitudes towards clients with borderline personality disorder There is evidence in the literature to suggest that mental health care staffs’ attitudes towards clients with borderline personality disorder (BPD) are less than favourable. This study reports on a survey of psychiatric nurses’ knowledge, experience and attitudes towards care received by clients with a diagnosis of BPD. The questionnaire was sent to all clinical nurses (n = 157) working in a psychiatric service in Dublin, Ireland and received a response rate of 41.4% (n = 65). The results indicate that the majority of nurses have regular contact with clients with BPD and nurses on inpatient units reported more frequent contact than nurses in the community. Eighty per cent of nurses view clients with BPD as more difficult to care for than other clients and 81% believe that the care they receive is inadequate. Lack of services was cited as the most important factor contributing to the inadequate care and the development of a specialist service is reported as the most important resource to improve care. Keywords: attitudes, borderline personality disorder, experience, knowledge, survey Accepted for publication: 13 July 2007 Correspondence: P. D. James Glenabbey Building Belgard Road Tallaght Dublin 24 Ireland E-mail: philip.james@mailm.hse.ie Introduction Borderline personality disorder (BPD) is one of the subtypes of personality disorders listed in the Diagnostic and Statis- tical Manual (DSM-IV) (American Psychiatric Association 2000). International research estimates that 2% of the population meets the diagnostic criteria for BPD and approximately one quarter of these will present with the severest symptoms and be well known to local psychiatric services (Krawitz & Watson 2003). The American Psychi- atric Association (2000) claims that the prevalence of BPD is as high as 10% and 20% among psychiatric outpatients and inpatients respectively. Although the rate of suicide for those with BPD is similar to that of schizophrenia and bipolar affective disorder (about 10%), the figure almost quadruples for those who have severe BPD (Krawitz & Watson 2003). Understanding nurses’ attitudes towards clients with BPD and the care they receive is likely to contribute to better care provided to clients diagnosed with this disorder. Research has shown repeatedly that negative attitudes are regularly held by various mental health professions towards clients with BPD. In addition, the services pro- vided for those with BPD have also received criticism with Nehls (1998) describing services as a ‘non-system of care’ because of the fragmented and disorganized nature of services. Nehls’ description of the US services may be a reflection of services elsewhere. It is hoped that this research study will contribute to our understanding of Journal of Psychiatric and Mental Health Nursing, 2007, 14, 670–678 670 © 2007 The Authors. Journal compilation © 2007 Blackwell Publishing Ltd