'Throw me a life buoy, please': A systematic review and thematic synthesis of qualitative evidence regarding nurses' experiences of caring for inpatients with borderline personality disorder and/or non-suicidal self-injury.

Abstract

Non-suicidal self-injury (NSSI) is prevalent in individuals diagnosed with borderline personality disorder (BPD), particularly in inpatient settings. This poses challenges, leading to frustration and powerlessness among healthcare professionals. This, in turn, puts mental health nurses at risk of compassion fatigue (CF), impacting treatment quality. We conducted a systematic review and meta-synthesis to investigate the experiences of mental health nurses caring for people with BPD and/or NSSI in inpatient settings. Literature search was performed in MEDLINE, CINAHL, PsychINFO and Web of Science. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. For synthesis of findings from original studies, Thomas and Harden's thematic synthesis was used. In total 1492 studies were screened of which seven met the inclusion criteria. We identified four main analytical themes: 'Notions on nursing', 'Reality calls', 'Fall of ideals' and 'Throw me a lifebuoy, please', with each two subthemes included. Despite nurses' strong motivations for positive change and assistance, unexpected demands lead to emotional exhaustion, affecting their care provision. The study underscores the necessity of addressing nurses' emotional strain through education and skill-oriented training, enhancing their resilience and reducing CF risk, ultimately securing adequate care, and improving patient outcomes.