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

1. 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

3. 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

4. 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.

5. 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)

6. 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.

7. 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

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

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

10. 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).

11. Demografics 17 participants 16 female’s, one male Mean age 43,8 years old Diagnosted with BPD Experience with BA > one year

12. Results • Organization of the Brief Admission • Elements of Brief Admission • Results of a Brief Admission

13. 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”

14. 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”

15. 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”.

16. 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”.

17. 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

18. 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”.

19. 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.

20. Questions…