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Experiences of patients with borderline personality disorder with the crisis intervention “Brief Admission ” A Qualitative analysis. M. Helleman Rn MScN T. van Achterberg Rn PhD FEANS P.J.J. Goossens Rn PhD APRN FEANS A. Kaasenbrood, MD, PhD.

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M. Helleman Rn MScN T. van Achterberg Rn PhD FEANS

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M helleman rn mscn t van achterberg rn phd feans

Experiences ofpatientswith borderline personality disorder with the crisis intervention “Brief Admission” A Qualitative analysis

M. Helleman Rn MScN

T. van Achterberg Rn PhD FEANS

P.J.J. Goossens Rn PhD APRN FEANS

A. Kaasenbrood, MD, PhD


What is a brief admission

What is a Brief Admission?

  • crisis intervention

  • a duration of maximum three nights

  • a clear treatment plan

  • a maximum number of brief admissions in a given period


Introduction

Introduction

A frequently used crisis-intervention is a "Brief Admission".

This is not an evidence based intervention.

Even in my organisation there are different protocols for every ward.

During my PhD study, an evidence base for this intervention will be build.

Knowledge about the experience of patients is an important building block for the development of this intervention.


M helleman rn mscn t van achterberg rn phd feans

Records identified via search of titles in database (n =1059)

Additional records identified via other sources (n = 2)

Records left after duplicates removed (n =1030)

Records excluded(n =942) on basis of title

Records screened on abstract (n = 88)

Abstracts excluded (n = 64) , not about BPD, lacking a description of BA

Full-text of articles examined for eligibility (n =24)

Articles excluded (n=14), not about BPD or lacking a description of BA

Studies included in qualitative synthesis (n = 10)


Results

Results

Five key components of Brief Admission as an intervention could be identified:

discussion of goals;

organization of Brief Admission;

clear admission procedure;

specification of any other interventions during Brief Admission;

stipulation of conditions for premature discharge.


Interventions during ba

Interventions during BA

  • Solely a stay in the hospital, which offered only the possibility of the occasional conversation with a nurse.

  • Active, rapid response to the psychiatric, psychological, interpersonal, financial, and/or housing factors contributing to the need for admission. Both individual and family sessions for crisis management and problem-solving.

  • Medication


Conditions for premature discharge

Conditions for premature discharge

  • The term “premature discharge” refers to a forced discharge due to violation of agreements on the ward for Brief Admission.


M helleman rn mscn t van achterberg rn phd feans

The aim of this study is to describe the lived experience of patients with borderline personality disorder with the intervention Brief Admission.


Methodology

Methodology

A phenomenological approach was used

A convience sample of 17 outpatients

Data were gathered through open qualitative in-depth interviews.

Data-analyse was proceeded using the steps of Giorgi (1997, 2008).


Demografics

Demografics

17 participants

16 female’s, one male

Mean age 43,8 years old

Diagnosted with BPD

Experience with BA > one year


Results1

Results

  • Organization of the Brief Admission

  • Elements of Brief Admission

  • Results of a Brief Admission


Organization of the ba

Organization of the BA

Reasons for asking for a Brief Admission

“For me, when the pressure in my daily live gets to high, to much stress, to much at te same time, I can call them. To come and try to relax again”

“When I have thoughts about auto mutilation, I feel there more save. There are less posibilities and there is someone to talk with”


Brief admission treatment plan

Brief Admission Treatment Plan

“I made the Brief Admission Treatment plan with my community nurse and the nurse of the clinic”

“Discuss with a patient what the expectations of the BA are. What is the goal? Put this on paper, individualy. What to expect from the clinic? Lets this be clear”


Elements of brief admission contact with a nurse a healing expierence

Elements of Brief Admission: Contact with a nurse, a healing expierence…..

  • Conversations with nurses are the most helpful in recovering from crisis;

  • Patients feel they are emotionally “locked up” or very tired or confused;

  • They need an active approach of the nurse, in which the nurse asks about the problems at home, and current thoughts and feelings of the patient.

    “The nurses think about things I cannot think of myself at such moments. What I can do to find distraction, par example”.


Elements of brief admission

Elements of Brief Admission

Daring to contact the nurse

“I am often not so clear when I ask for help. To find the words is hard in a crisis situation. I haven’t slept for days and my head just doesn’t work that well. My logic is gone”.

“If there is a nurse I know and trust, I dare to go and ask for a talk. I avoid the others”.


Brief admission elements

Brief Admission Elements

Admission conversation

“When I arrived I have a conversation with the nurse. What do you need? What can I do for you? With whom will the conversations be? So that’s all clear to me”.

Distraction

Structure

Fellow patients


Outcome of a brief admission

Outcome of a Brief Admission

  • Positive

    ‘Can’t say the whole crisis was over, but I came home more relaxed and was able to work again”.

  • Negative

    ‘If I can’t talk to someone, it has no use. I rather stay at home, then”.


In conclusion

In conclusion

Brief Admission is a welcome escape from crisis and can work preventively.

A clear plan with goals is crucial for patients.

During their crisis it’s hard for patient to be responsible for initiating conversations with the nurses.

Conversations with the nurses are essential to reduce tension.


Questions

Questions…


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