Nursing Research Mental Health

The aim of this assignment it to select a policy, protocol or guideline underpinned by research which relates to mental health nursing. The assignment will then focus on analysing three pieces of research which supports the guideline, reviewing its relevance to care delivery. I will then go on to discuss how clients and their carers' were involved, or could have been involved in the research. Finally, I will explore any obstacles to clients informing nursing practice and make suggestions on what could be done to overcome these issues.

The guideline chosen for this assignment is entitled Borderline personality disorder: Treatment and management, National Institute of Health Care Excellence (2009). My rationale for this choice is that so far in my practice I have had little experience working with clients who have a borderline personality disorder diagnosis. I am aware of the fact that social stigma has long been associated with any mental health diagnosis, however borderline personality disorder presents its own set of issues with even some professionals viewing clients in a negative or derogatory way. The potential risks and suicidality associated with this disorder cannot be overlooked and research suggests this can be a lot more severe than risks associated with schizophrenia or bipolar disorder (Krawitz and Watson 2003). Studies indicate that nurses believe clients with borderline personality disorder are more difficult to care but equally feel that clients with this diagnosis receive inadequate care for their condition (James and Cowman 2007).

The articles selected are: Nehls (1999) Borderline personality disorder: the voice of patients, Research in Nursing and Health; Stalker, Ferguson and Barclay (2005) 'It is a horrible term for someone': service user perspectives on 'personality disorder', Disability and Society; and Horn, Johnstone and Brooke (2007) Some service user perspectives on the diagnosis of borderline personality disorder. For the reasons already outlined the articles selected all centre around the service users' perspectives and experiences of having and living with a personality disorder diagnosis and their views of services put in place to support them. The Nursing and Midwifery Council 2008 require all nurses to listen to the people in their care and respond to their concerns and preferences. Therefore I think it is important for all professionals working with service users to gain an understanding of the individual's perspectives and experiences. Taking this into account I decided to review articles that adopt a qualitative methodology as this style of research seeks to understand the way people make sense of their experiences and the world in which they live (Holloway and Wheeler 2010).

To assist with structuring of my appraisal I will draw upon questions from the critical appraisal skills programme tools. The studies conducted by Horn, Johnstone and Brooke (2007) and Nehls (1999) both adopt an interpretative phenomenological approach and sought to gain an understanding of the lived experiences of people with a borderline personality disorder diagnosis. Both articles provide a sound rationale for adopting this study design and use the methodology effectively and clearly throughout; allowing the reader to gain a good insight into the experiences and opinions of the participants' (Polit and Beck 2012). Horn, Johnstone and Brooke provide comprehensive review of the literature of the time and identify a clear gap in knowledge.

Alternatively Stalker, Ferguson and Barclay (2005) use a grounded theory approach but fail to provide a suitable rationale for deciding on this method. The article also refers to both Glaser and Straus (1967) and Straus and Cobain (1999) which are two different approaches to grounded theory research. Without any clear statement from the researchers it is difficult to determine which model they choose to adopt and whether or not the study design was implemented throughout. Parahoo (2006) suggests that a grounded theory approach is used to develop substantive theories by studying the social psychological process that people experience.

All normal ethical considerations were adhered to in all three studies and informed consent was provided by all participants. This is of particular importance taking into account that some participants would be considered as vulnerable and some were inpatients so may been detained under the Mental Health Act 1983 (2007). Polit and Beck (2012) state that studies can only commence once participants have adequate information about the research, can comprehend that information and have the ability to consent or decline involvement. Holloway and Wheeler (2010) add that consent should always be an ongoing process in research and should not be assumed as a once and forever agreement by participants.

According to Parahoo (2006) sampling is paramount and researchers should always seek to describe their sampling methods adequately, allowing the reader to assess whether the findings could be transferable to other settings. All three studies used a purposive approach to sampling and concisely outlined there recruitment strategy, however all three fail to discuss why people decided not to take part. One of the clear weaknesses of using a purposive sampling method is that those who decide to take part in the study could be those with stronger views and could therefore sway the findings in a particular direction. Horn, Johnstone and Brooke (2007) acknowledge limitations to using a purposive approach are present and suggest that other people with the same diagnosis may experience things differently to what the data suggested but chose not to take part.

Stalker, Ferguson and Barclay (2005) aimed to recruit 24 service users, comprising of equal numbers of men and women, however the had considerable difficulties at this stage and only recruited 10 out of 15 people put forward. They do recognise a weakness in that women were disproportionately presented and that a sample with more males could yield a different result. They add that the difficulties with recruitment produced findings based on a smaller scale that they desired; nevertheless they believe the overall aims of the study were still achieved.

The most common form of data collection in qualitative research is interviewing and this method was adopted by all three studies (Holloway and Wheeler 2010). Researchers adopted a semi structured approach to their interviewing using interview schedules; the benefit of this style of interviewing is that control by the interviewer is minimised to allow topics and perspectives to emerge (Parahoo 2006). Stalker, Ferguson and Barclay set up a reference group which included a service user; this group provided advice on the topic guide. Comparatively, the