Mental Health Nursing: Exploring BPD, Suicidal Ideation in Adolescents

This report presents a qualitative study exploring the relationship between adolescent patients with Borderline Personality Disorder (BPD) and suicidal ideation, examining frequency, period, and starting age using both clinician-rated and adolescent-rated assessments. The study references case reports and the use of Cognitive Behavioral Therapy (CBT) and other therapeutic interventions. The author used the PEO framework to evaluate the effectiveness of interventions, including Brief Cognitive Behavioral Therapy (BCBT) and Dialectical Behavioral Therapy (DBT). The research highlights the importance of primary research, peer-reviewed journals, and databases like CINAHL. Inclusion and exclusion criteria were used to ensure the accuracy of the questionnaire. The report emphasizes the evolution of the nurse's role and the significance of evidence-based practice in mental health nursing, and references inclusion/exclusion criteria, and the importance of peer-reviewed academic journals. The study aims to contribute to advancements in mental health nursing care for adolescents with BPD.

Mental Health Nursing Theory Four
Evidence Based Practice and Complex Mental Health Needs
Word Count: X

This qualitative study has aimed to explore adolescents with Borderline Personality
Disorder (BPD). BPD is a complex psychiatric condition and individuals with this condition
have an unstable and insecure self-image, a dangerous tendency to self-harm, suicidal
behaviours, transient and dissociative symptoms that are intermittent and persistent
(Linehan, 2018). However, the research shows 8 - 10% of those diagnosed with BPD
commit suicide (Anderson, 2016). The study aimed is to investigate the relationship
between adolescent patients with BPD and the characteristics of suicidal ideation, for
example; frequency, period and starting age. This topic is examined using both clinician-
rated and adolescent-rated suicidal ideation, attempts to evaluate, assess qualitative and
numerical BPD. The results of this research indicate that earlier in their lives, adolescents
with BPD experience suicidal ideation, and more frequently than clinical controls. Notably,
the groups ranged not in terms of the adolescent-rated suicidal ideation magnitude or
length, intent to commit suicide.
The authors describe the case reports of a 19 – year - old girl who after a traumatic
childhood, began to deliberately self-harm often by cutting her forearms (Rashid and
Gosai, 2011). The authors mirrored a storey on the National Centre for Biotechnology
Information (NCBI). The authors had the opportunity to visit psychiatric hospital, recovery
college, day centres and other locations where groups of mental health patients meet for
day – to - day activities. Authors work closely with different patients to build trust and the
therapeutic relationship. Therefore, some of them shared their experience on how self-
harm affected their lives with deliberately negative thoughts and how meeting with other
peers with similar stories helps to build their confidence. Accordingly, the authors chose to
do more research.
They examined on what more can be of advantage rather than meeting for
activities, as the authors say that the psychosocial or pharmacological treatment for self-
harm (SH) in adolescents (up to 18 years of age) is not broadly utilised in practice, and the
BPD awareness of mindfulness must be used to classify all randomised controlled trials
(RCTs) of CBT. Moreover, the authors have been inspired as a future mental health
nursing to the attendant to advance non-medical intervention, and that drives the craving
of needing to build knowledge. Hence, the longing was to explore the subject on the
adequacy of care as therapeutic interventions for individuals who are self-harm or suicide
attempts. Venta and colleagues (2012) state that suicide ideation or attempts self-harm is
a significant health issue among young people where recent research has emerged that
borderline personality disorder (BPD) may pose a much greater risk to individuals alone
NT4 - Mental Health Nursing Page | 2

without having depression. However, a few studies have examined the association
between BPD and attempted suicide among younger’s and little is known about the
attribute of suicidal ideation BPD at this time. However, for individuals with distressing self-
harm, there seems to be a prior lack of study or analysis formerly. While conducting the
literature Spirito (2002) found that facilitated therapy groups for continuing distressing self-
harm with healthy study outcomes and there is growing evidence recently. The problems
faced by the author were to find a research paper comparable to the choice of question.
The question formulated by the author was the intervention for young people, who self-
harm (SH), suicide attempt (SA) or suicidal ideation (SI). The subject closing the question
framed for a quantitative research paper was (Cognitive behavioural therapy for suicide
prevention in youth admitted to hospital following an episode of self-harm: A pilot
randomized controlled trial) and for the qualitative paper was (Psychosocial interventions
for self-harm, suicidal ideation and suicide attempt in children and young people).
Therefore, this qualitative study paper was also specifically designed for adolescents who
psychological distress and is considered one of the criteria for suicidal death that the
author reflects on.
However, the qualitative research on Short Cognitive Behavioural Therapy (BCBT)
for suicide prevention versus an attentional control group (minimally-directive supportive
psychotherapy) for adolescents hospitalised after SH examined (aged 16–26). Both
treatments involved ten acute 15-week cycles and three booster sessions taking effect at
three-month periods afterwards. The primary effectiveness result was more than 70%
retention at the endpoint of the analysis.
Though, it has been CBT's pros and cons. Cognitive Behavioural Therapy focused
on the biopsychosocial perspective of emotional reaction, such as feelings and behaviours
arising from patient thoughts, according to the Nationwide Association of Cognitive-
Behavioural Therapists. CBT, unlike its psychodynamic counterparts, is a goal-oriented
and problem-focused treatment. As a method, Cognitive Behavioural Therapy emphasises
on the present, rather than on a comprehensive examination of the developmental history.
A pilot randomised controlled study suggested that Trauma-Focused Cognitive-
Behavioural Treatment (TF-CBT) has numerous benefits for youth, such as devastating
occurrence CBT, which aims to reduce both emotional and behavioural symptoms
stemming from traumatic stress.
Research has found that Cognitive Behavioural Therapy can be as successful as
medicine in the treatment of self-harm and other psychological issues. CBT usually
completed over a brief period like other talking therapy. However, to benefit from Cognitive
NT4 - Mental Health Nursing Page | 3

Behavioural Therapy, individuals need to dedicate themselves to the process. However,
they maintain the quality of Cognitive Behavioural Therapy; it may not be suitable for
people with more complex mental health needs or physical disabilities. As CBT can
include expressing their emotions and negative feelings, individuals may perceive initial
times where they feel more nervous or emotionally insecure. Other challenges might be
other terms that had been used primarily in quantitative paper, such as schizophrenia,
cognitive behavioural therapy for psychosis (CBTp), which contradicted the question
formulated. While constructing a research question, method of 'Population, Exposure and
Outcome (PEO) or Population Intervention, Comparison and Outcome (PICO)' is the
standard framework for planning the clinical question, particularly patients relating to the
effectiveness of (intervention) therapies and for identifying keywords of the search for
disorder emerging from the concern of a patient or population. Therefore, mainly used in
medical fields to support medical practitioners improve and recognise main terms that
make it simpler to look for evidence. (Stern, Jordan, and McArthur, 2014). These models
often concentrate on how to analyse the literature database and not just on science .
(Oermann, and Hays, 2015). The author used PEO framework to evaluate whether a pre-
existing disorder or exposure is likely to occur in or in progress from a specific diagnosis.
See Table 1, for main terms and the corresponding synonyms and then using the relevant
mental models of Boolean concepts (Goodwin and Johnson-Laird, 2011, p.34)
Table 1. Research theme utilising the PEO framework:
P Population Adolescents / young adults
experiencing self-harm (SH)
E Exposure Borderline Personality Disorder
(BPD) or psychological distress
or emotion dysregulation
O Outcome Preliminary effectiveness
success of Brief Cognitive
Behavioural Therapy (BCBT) for
suicide prevention or Dialectical
Behavioural Therapy (DBT)
NT4 - Mental Health Nursing Page | 4

The PEO designed inclusion and exclusion criteria to support the accuracy of the
questionnaire collected in practice, for example; the inclusion criteria set limitations for the
researcher to specifying what theoretically included, entirely irrelevant to the subject or
component of the participation qualifications (Stern, Jordan and McArthur, 2014). Also,
inclusion models help minimise the specific inclinations of the reviewer, ensuring what
reports are selected independently from analysts relevant, bound into a biased framework
or align emerging outcomes on the predefined, rational criteria (Aromataris and Pearson,
2014).
The inclusion criteria typically comprise angles such as the method of analysis, type
of information (qualitative or quantitative), the phenomenon under review, year of research
or group of participants (Stern and colleagues, 2014). While exclusion serves as a tactic to
avoid much less optimised results and seeks to eliminate prejudice, for example; excluding
papers dependent on language bias may introduce into the survey, restricting the
adaptability of the outcomes (Geerligs et al., p36, 2018).
Nonetheless, this might be strenuous to avoid as translating articles is frequently
unrealistic. Whatever the inclusion criteria, they should be legitimate and adequately
documented in a protocol depending on the prerequisites of the sample. Kallio et al. (2016)
point out that inclusion and exclusion requirements are often crucial to their reflection on
the qualitative data of outcomes. The researchers establish criteria to decide whether a
person is eligible as a member of the population or excluded. Table 2 outlines the inclusion
criteria used by the hypothetical question and indicates the methodological forms of
justification used in a quantitative systematic review protocol.
NT4 - Mental Health Nursing Page | 5

Table 2. Criteria for inclusion and exclusion:
INCLUSION EXCLUSION
Primary research study Secondary research study
By peer reviewed /academic journal are
used in the study for gathering data on
the topic.
Unclassified theoretical or non-academic
research on BPD awareness of mindfulness
is excluded.
2020 onwards Pre - 2020
Groups - Adolescents/Youth/Young
Adults
Adults / included children under the age of 12
years
Journals Articles - Journal of Affective
Disorders
Textbooks
Brief Cognitive Behavioral Therapy
(BCBT), Dialectial Behavioral Therapy
(DBT), or Minimally-Directive Supportive
Psychotherapy (Control)
Antidepressants, Antipsychotics or Mood
Stabilisers (including antiepileptics)
medications
A pilot randomized controlled trial (RCT) Meta-Analyses (MAs) to combine the
outcomes of multiple scientific studies is not
included.
NT4 - Mental Health Nursing Page | 6

Nurse’s position has essentially progressed in the 21st century. Nursing research
conveys an awareness of the nursing practice and its impacts on patients much like
everyone’s in communities. The upheld scientists at the National Institute of Nursing
Research (NINR) explore and approaching nursing research as critical to the nursing
profession and is necessary for proceeding with progressions that facilitates optimal
nursing care (Tingen et al., 2009). Nurses work in a diversity of settings, including the
hospital or the community health setting. While each position conveys various
responsibilities, the essential objective of a professional nurses remains the same, to
support the patients and offer optimum treatment based on evidence gained through the
observation. Hence, nursing research is imperative to the practice of professional nursing,
and the significance of their inclusion cannot be overemphasised during undergraduate
guidance (Fain, 2020).
First-hand, the author, included primary research and excluded secondary research
because primary research uses more resources than secondary research (usually more
time-consuming). Author’s best interests are primary research after the gaps in available
secondary research have established. However, it is a calculable and proven method of
practical analysis, relying on the information gathered, and help nurses to create strategies
and solve problems based on the knowledge they accrue (McCrocklin, 2020). For
example, collected the data, surveying a specific population, developed and performed an
experiment, conducting a focus group, observing a particular population/task, primary
research provided the growing emphasis on evidence-based nursing practice in the
Western world (Sullivan, 2013). The author excluded textbooks which take longer to
publish and include journals which are a formulated source of the latest information on
nearly all subjects as well as the latest study results and preferred mode of communication
(Wood & Haber, 2018).
Looking for theoretical, research or clinical articles, the author prioritised peer
reviewed academic journals. In addition, (Haber & Wood) for possible publication, there is
a board of internal and external inspectors who submits manuscripts and ensure it’s
unbiased. Though peer review has been weighed as not constantly being an effective,
however it gives the readers assurance that it meets satisfactory standards of scholarship
discussing reliability and authenticity on an author’s work (Mateo & foreman, 2014).
NT4 - Mental Health Nursing Page | 7

The author used the bibliographic reference of the Cumulative Index for Nursing
and Allied Health Literature (CINAHL), which offers indexing for over 3,000 nursing, allied
health, scientific and consumer health journals. Some databases are considered more
useful than others for specific types of review, and CINAHL is generally considered a
successful source to search when conducting qualitative research (Murphy and Cowman,
2008, p.75).
Two case studies investigated CINAHL’s performance. One study by Subirana et al.
(2005) felt it necessary to search both CINAHL and MEDLINE to identify all related studies
included in a systematic review covering a nursing subject. The author suggests that
CINAHL could be a better option for qualitative analysis studies than MEDLINE because it
covers a broad spectrum of cases in the literature, biomedicine, health sciences
databases, and 17 associated health disciplines (Alpi, 2006). Also, found some evidence
that CINAHL includes specific research for systematic reviews and verify all the databases
which originated from the study.
The general objective was to locate the one with the highest published articles by
the research question. CINAHL, therefore, used to search for keywords by combining
terms using “OR”, author goal was to achieve search techniques of 100% sensitivity and
100% accuracy, and by using “AND”, to achieve at least 50% specificity (Tanon el at.,
2010). Research conducted on patients with a range of long-term conditions shows the
main expectations affecting critical thinking assessments of a pharmaceutical drug.
However, patients can group into two categories, for example; perception of personal
treatment needs (Necessity Expectations) and a range of possible adverse effects. This
‘Necessity-Concerns Framework (NCF)’ will provide clinicians with a convenient model to
elicit and address core principles supporting patients’ behaviours and care decisions
(Horne et al., 2013). Based on this study, CINAHL has the best coverage of literature
beyond nursing articles, the most extensive access to biomedical titles and the highest
accessibility for nursing practice, including allied health literature (Jacobs and Levy, 2006).
It also has hundreds of full-text publications identified in the broader volume of records
dating back to 1937 and expanded content (Oermann and Hays, 2015). See Table 3 below
for further information.
Table 3. Results from the search:
Search No. Search Words Results From
CINAHL
S1 Adolescents* OR Youth* OR Young Adults 383,301
NT4 - Mental Health Nursing Page | 8

S2 Self-harm* OR Suicide Attempt* OR Suicide
Death* OR Suicidal Ideation* OR Suicidal
Thoughts/Behaviour* OR Non-Suicidal Self-Injury
23,237
S3 Brief Cognitive Behavioural Therapy* OR
Cognitive Behavioural Therapy* OR Minimally-
Directive Supportive Psychotherapy* OR
Dialectical Behavioural Therapy* OR Emotion
Regulation Group Therapy* OR Family Therapy*
OR Brief Contact Interventions
22,578
S4 Primary Feasibility Outcomes* OR Preliminary
Effectiveness* OR Benefits* OR Effects* OR
Impact* OR Efficacy Measures
1,398,506
S5 S1 AND S2 AND S3 AND S4 To be
complete
Database search
limits used The data older than 2017 is not included
To be
complete
By date < 10 years
old 2020, 2017
To be
complete
By peer reviewed
academic journal
type
PUBMED, ELSEVIER
To be
complete
By full text,
language/geography
(or any other
database filter)
Date, country/ region, values,
To be
complete
Table 4. Qualitative Summary Table:
Qualitative Paper
NT4 - Mental Health Nursing Page | 9

Cox, G. and Hetrick, S.
2017
Victoria, Australia
Author
Date
Country of Origin
Aims To identify evidence for the effectiveness of individual
psychosocial interventions on suicide-related behaviours
(SRBs) in children and adolescents up to 25 years of age,
and to facilitate a holistic approach with particular emphasis
on form setting of the intervention, as well as the method of
delivery to suicide reduction.
Methodology To find systematic reviews (SRs) or meta-analyses (MAs)
conducted within the context of an SR. SRs is comprising
published or continuing randomised controlled trials (RCTs) of
individual therapeutic interventions delivered to children or
adolescents up to age 25 years who had experienced SH, SI
or SA. SRs included trials where the primary or secondary
outcome was SRB or incidence suicide.
Data Collection The U.S. clinical data group survey reveals that 24% of young
people between the age of 12 and 17 have SI over the past
12 months and that between 10 and 17% have SA. However,
in psychiatric specimens, this incidence is more significant,
with up to 85% of young people who already have suicidal
symptoms showing SI. Moreover, 32% of clinically referred
children and teenagers are SA, and 2.5% and 7% are dying
from adult suicide.
Population and Sample Four SRs has fulfilled the criteria for this review; it was agreed
that all four of them were worthy of inclusion and exploration
within this review because of variations of inclusion criteria,
qualitative techniques, and the database searched. One of
these SRs provided psychosocial interventions for adolescent
suicide across a range of settings which included RCTs
promoting standardized, selective and suggestive groups.
Two SRs focused on youths who had been submitted to
psychiatric care by SH or SRBs, including active SI, and the
other SR, it focused on web-based and digital psychosocial
suicide intervention for adolescents. Three of the studies
NT4 - Mental Health Nursing Page | 10

involved trials for young people between the ages of 12 and
25 years, and one included trial with participants up to the
age of 18 years. This review describes sixteen individual
practices from these four SRs. A Shand et al. (2013) included
as a Perry et al. (2016)'s unpublished trial in the SR was
significant as this review was prepared, this has therefore
already been published, and the total age of participants is
26.25% for a variety of ages of up to 61 years and are thus
excluded.
Data Analysis Strategy Alavi et al. (2013) used a waitlist analogy to test a Cognitive
Behavioural Therapy protocol developed primarily to address
SRBs based on the Stanley model. The main components in
these involve chain analysis (examination in circumstances,
problem-solving training, cognitive restructuring,
psychological management, distress tolerance strategies and
problem-solving to resolve the processes that sustained SH,
emotions and behaviour occurred before and at the moment
of the SA), safety planning, psycho-education, development
of motivations for living and hopes, therapy and cognitive
therapy, mood monitoring, psychotherapy for psychosis and
distress tolerance strategies, physical pain, stress
management, self-esteem, research and social assistance
skills training. Parents were required to participate in the first
session and, if necessary, 'standard psychiatric treatment'
was used for medication given to all groups. Slee et al. 2008
have implemented a CBT protocol directly addressed to SH
but created the protocol themselves where parents were
invited to act as supporters.
Key Findings The comparison group obtained sources of support interview,
and both groups received whatever support in the community.
For example; Two trials have used green cards or postcards
to deliver their interventions, which did not involve any
ongoing therapist contact. One trial assessed the
effectiveness as a form of proximal support method to
adolescents who had been admitted to the hospital for an
episode of SH was issued a token (referred to as a green
NT4 - Mental Health Nursing Page | 11

card). They use it to readmit to the hospital facility. The goal
of the green card was to offer an alternative route for
adolescents to exit to get support from their situation. Another
trial used postcards that were delivered to participants every
month that included individual support outlets (identified in an
initial 'sources of help interview' where young people were
questioned what they find helpful in moments of distress,
such as listening to music or chatting to a friend) as well as
evidence-based self-help strategies. The postcards often
inquired for the well-being of the adolescents.
Conclusions Some of the trails listed in this analysis did not consider to be
relevant variations in the outcomes of SI, SA and SH between
groups, whereby the aim is not to perform an MA; it makes it
challenging to suggest specific therapeutic approach over
another. The systematic investigation urgently required in this
field, and given the possible effectiveness of Cognitive
Behavioural Therapy, DBT and MBT in the treatment of SI
and SH in other population groups, these are opportunities
suitable for further research. The face-to-face delivery of
therapy has driven intervention trials until date, the usage of
the internet, social media and technology devices in young
people have provided a unique and modern approach to
suicide reduction. To design and analysis interventions for
young people that can be provided throughout their lifetime
which can be beneficial, as well as implementing smart
technology to assist parents as an alternative to individual
counselling.
Table 5. Quantitative Summary Table:
Quantitative Paper
Sinyor, M. et al
2020
Toronto, Canada
Author
Date
Country of Origin
Aims The first randomised controlled trial investigating group
NT4 - Mental Health Nursing Page | 12