Hey, I want to be a public health nurse. I am great at prevention and promoting healthy lifestyles, med surg type stuff, but I am not that great at psych. So, I am trying to really go through and learn about the psych illnesses more than what I learned in class (I don't feel like my instructor was effective at all). I am having an okay time learning most of them. But, personality disorders baffled me; especially, borderline.
I don't understand it. What are they like? I have read they are manipulative, but I don't understand what kind of stuff they do that is manipulative. I understand the black and white stuff like a person is all good or all bad. Are they cheery people or are they depressed? Do they really lie a lot; have you ever met an honest one? Does that mean I should take what they tell me as being true? Have all of them been abused or are some of them just like that without abuse? Are they able to hold down jobs and what kind of services would I need to refer them to (I know it's on a case by case basis but generally what kind of advocacy/ case management do they need?) How does this differ from Bipolar?
Any info is appreciated. I had considered joining a psych organization along with the couple other ones I have selected to join just so I can get info and journal articles about psych illnesses, homelessness, etc. in order to learn about and advocate for my future patients. Like I said, I understand med surg slightly better but I am not close minded or think psych patients are crazy or anything.
Apr 26, '12
by Meriwhen, ASN, BSN, RN Senior Moderator
so far you've gotten some good info.
i wanted to add that not every difficult patient you encounter is a borderline personality disorder patient.
there tends to be a bad habit, especially in non-psych nurses or nurses who don't understand personality disorders, to immediately slap the "borderline" label on any patient who is demanding or difficult, changes their mind a lot, is seeking sympathy, and/or tells staff different stories.
patient changes their mind about something? must be borderline. not happy with dinner or a medication and wants something else? must be borderline. minimizes pain to the nurse but tells the doctor they are in agony? must be borderline.
yes, most of these "difficult" patients probably have borderline pd to some degree. but not all do.
some patients are just indecisive. some are just entitled. some indeed just want a shoulder to cry on. some may tell varying stories, not to split or manipulate staff, but for other reasons: maybe they don't want the doc/nurse know how bad off they really are, maybe they forgot to mention something, maybe they didn't want to bother a busy nurse for pain meds, maybe they are stressed or in crisis and not thinking clearly, maybe they relate better to one staff over another, etc.
just something to keep in mind.
that being said, regardless of whether the patient has borderline pd, remember to be consistent with boundaries and unit rules. take what the patient tells you with a grain of salt, and do not let them split staff whether they do it intentionally or accidentally. and definitely learn not to take things they say or do personally.
the best way to learn about personality disorders (borderline pd is only one of several you will encounter--antisocial pd, narcissistic pd and obsessive-compulsive pd are also common ones). there are lots of good reference books out there. if you want to learn about borderline pd from the patient pov, look for "get me out of here" by rachel reiland.
Last edit by Meriwhen on Apr 26, '12