Critique of article of Mental Health Professionals’ attitudes and difficulties in dealing with people with Personality Disorders
Personality disorders are described as conditions that mostly occur during adolescence and bring about profound changes in adolescents’ behaviors and emotions within their social groups and cultures (Eren & Sahin, 2016). Mental health workers occasionally find it difficult to deal with persons suffering from mental health disorders depending on various factors. A lot of research has already been conducted with regard to the welfare of persons suffering from personality disorders and the difficulties that the mental health professionals have in dealing with them.
The purpose of this study is to evaluate the efficiency of Eren and Sahin’s (2016) article in articulating the difficulties that mental health workers (MHWs) have in addressing the plight of persons with personality disorders (PDs) and their attitudes towards the same. This research critique will essentially help to examine the relevance of the article’s findings with regard to its representativeness in outlining evidence-based practices such as looking at previous studies, and analysing patient demands and conditions in addition to the expertise of various mental health workers in an integrative manner. The article under critique is: Eren, N. & Sahin, S. (2016). An evaluation of the difficulties and attitudes mental health professionals experience with people with personality disorders. Journal of Psychiatric and Mental Health Nursing, 2016, 23(1), 22-36.
Authors
The study under critique was conducted by highly qualified personnel based on their professional training and management in the psychiatric field of study and administration. Eren is a psychiatric medicine PHD holder while Sahin is the Managing Director of the Psychiatric department at the University of Istanbul. Their level of expertise and experience in the psychiatric field compels the researcher to believe that the authors are credible and competent to have undertaken this study; hence the validity of its findings and recommendations. The main strength of the study’s authors is their professional level of training and experience in management of persons with PDs, which gives them in depth insight of the required field of study. A critical look at what the authors researched and their experience shows that they were competent to do the study, meaning that no apparent limitations serve to detract from their status as researchers.
Literature Review
In the literature review, the study comprehensively addresses the various attitudes of the MHWs towards persons suffering from PDs; it defines the PDs in addition to reflecting on other earlier research concerning PDs. The study outlines the factors that influence the level of attitude and concern for persons with personality disorders among mental health professionals. It equally elucidates the stigmas that PD patients endure at the hands of MHWs, such as those suffering from Borderline Personality Disorders (Chugani, 2016). Studies on the attitudes and difficulties experienced by MHWs are extensively dealt with in this literature review and this helps to give a very clear picture of the problem in society throughout the years. The major strength of the literature review in this study is that it elaborately illustrates the types of difficulties that MHWs are constantly subjected to during the course of service delivery to persons with PDs; this is in addition to clearly indicating the main factors that are likely to influence their attitudes towards these patients (Black et al., 2011). At the same time, the review fails to give detailed analysis of the main challenges that persons with PDs face regarding their mental health conditions, or provide detailed information about the therapies that could remedy these disorders. This is can be regarded as a major limitation of the research article.
Research Gap and Study Purpose
The authors in this study observe the relationship between the difficulties MHWs face in handling people with PDs and their attitudes to people with PDs, but this has not been researched in depth. According to the authors of the article, the untapped research regarding these relationships form a major research gap that needs to be addressed. For this particular study, the main research purpose was to ascertain the difficulties that MHWs face in handling persons with PDs in addition to evaluating their attitudes to the patients. The study focused on the affective reactions of the MHWs towards PD patients, briefly checking on the interactions between all the study variables and objectives.
Consistency between the Lit Review, Problem and Purpose Statements
The coherence level of the study is exceptional as the authors admirably interlink the various study sections, from the purpose of the study and the problem statement, to the literature review. The information contained in the various study sections is wholly tied to the realization of the study purpose and objectives, hence the reason why the literature review for instance provides a lot of citations regarding the challenges MHWs face in their line of duty. The study is consistent with the topic of study, resulting in precise evaluation of the difficulties and attitudes which influence factors in the results section of the study. From the results and the flow of information throughout the various study sections, it can be deducted that the study sections consistently interlink with each other.
Target Population, Sample and Sampling Method
Target Population
The study by Eren & Sahin (2016) was mainly focused on addressing the welfare and concerns of the MHWs who also served as the target population of the study. The population sample on N=332 was picked through random sampling to represent MHWs target group in Turkey. However, because the study focuses on giving a verdict of the situation throughout Turkey, I feel that the selected sample of the target group is insufficient. In line with evaluating the welfare of the target population, it is important that the persons with PDs are included in the target population to aid in defining their take on the care they receive from MHWs. To avoid encountering any hostilities, it would furthermore be prudent to include rehabilitated persons who previously suffered from a PD in the study’s target population group.
Sampling Procedure
The use of the random sampling method has been credited as one of the best study techniques to aid in the reduction of various possible study errors such as bias. In this study, the use of the random sampling method is obviously plausible as is the use of self-report questionnaires. The sampling procedure of partitioning the MHWs into portions of the main sample and seeking permissions before administering the questionnaires is a noble move. This sampling procedure is likely to be devoid of bias, resulting in comprehensive and consolidated results.
Sample Characteristics
The selected sample sizes are social workers (n = 4), psychologists (n = 30), psychiatric nurses (n = 140), nurses (n = 88), psychiatric residents (n = 32), and psychiatrists (n = 38). These fragment sample sizes represent the overall sample size of N=332 which is actually large enough to provide a well-represented study group. However, the larger the sample size, the greater the representativeness of the sample, hence the study is not sufficiently representative of all MHWs throughout Turkey. The selection of only eight clinics from various regions in Turkey seems insufficient and therefore fails to deliver the most accurate representation for the study.
Sampling Method
The sampling technique and characteristics of the study is good and is sufficient to meet the study purpose although it never gives an accurate outline of the study purpose. The cluster sampling technique used to determine the eight clinics for consideration however is very representative of the institutional study population, since it comprises university clinics, state mental health institutions and private hospitals. Throughout the process, it is clear that the various institutions that offer mental health services to patients across Turkey are well represented by their MHWs, indicating that the study is comprehensively representative regarding the category of institutional classifications.
Research Design, Independent and Dependent Variables
The research is a descriptive research that uses the questionnaire method to collect quality data, as illustrated by (Hyett, Kenny, & Dickson-Swift, 2014). The main variables for evaluation in this research are the attitudes of the MHWs towards persons suffering from PDs, the difficulties they experience in handling them and their emotional interactions. The descriptive research design is well suited for this study as it endeavors to use the questionnaire survey method to acquire data for more detailed analysis. A mixed method would have been better to help put more focus on what other authors also suggested or even to interview professionals in the field with regard to the subject matter. Through interviews, coding would have helped to suggest a series of themes to help create better focus for the study.
Data Collection Process and Analysis
The data used for this research was qualitative data, collected from a target population selected through a cluster sampling method (Hyett, et al., 2014). In the process of collecting this data from people who had experience with persons PDs, the study used questionnaires. The questionnaires used in the study were the Attitudes towards Patients with Personality Disorders Scale (PD-APS), the Difficulty of Working with Personality Disorders Scale (PD-DWS), and the Personal Information Questionnaire (PIQ) (Eren & Sahin, 2016). These instruments were used to aid the study achieve its objectives. The PIQ was administered as a draft in the first instance to about 81 respondents, fully representative of the target population. The final PIQ draft was then administered to the target population of 332 respondents either through direct delivery to the respondents or through mailing the questionnaires. The questionnaires were delivered to selected samples of respondents who were required to fill in all the necessary socio-economic and demographic data.
Through the personality disorder scale, the total test score for every question was evaluated to help gauge the difficulty levels as seen in a study by Eren (2014). Test scores below 12 were regarded as low difficulty experiences while scores of more than 45 were considered high difficulty experiences. Through the questionnaire data responses, the researcher developed an attitude scale to help determine the MHWs attitudes towards persons suffering from PDs. Through the questionnaires, questions requiring responses such as seldom, always and so on, are gauged for attitude through the PD-APS scale. Through this scale, it is presumed that respondents who get scores of less than 6 on the measurement scale have negative attitudes while those who score more than 26 on the scale have positive attitudes. To ensure a rigorous process of data collection and analysis scales measuring the level of difficulty and attitudes are very essential in ensuring qualitative and accurate representation of the true feelings and perspectives of the respondents.
Strength and Limitations of Data Collection
This data collection process is reliable because the use of the questionnaire draft allowed the researchers to rectify any mistakes and accommodate any corrections to ensure that they had collected the most reliable data. The data collection process is accurate, providing that sufficient follow-ups are undertaken to ensure that all the administered questionnaires are fully completed and returned for proper analysis and evaluation. This study presents a good data collection method although I am inclined to raise issue with its efficiency in ensuring that all the data collection tools are returned for analysis.
Protection of Participants
The respondents in this study are protected by their independence to choose whether to participate in this study without coercion. This means that it is their sovereign mandate to either decide to partake in the study or to decline. Additionally, the information provided by participants in the study in purely aimed at facilitating the study and participants are therefore well protected from unwarranted external use or victimization for the opinions they provide to aid the purposes of the study. Eren & Sahin’s (2016) data collection process is guided by a number of ethical issues to ensure that the dignity and safety of all study participants is well maintained. Firstly, the data study ensures that participants are not coerced into participating in the study since their choices are purely optional. Secondly, the data collected is treated with a high level of confidentiality to ensure that no leakages occur. Any disclosure of private data to the public could probably result in issues of lack of dignity in society, which could seriously haunt the participants. To wind up, the data collection process ensures that the data collected is purely meant to aid in the accomplishment of the study objectives alone. Hence, the study does not allow for any other use of the data beyond the original objectives, a fact which respondents are made aware of in advance. Thus, through these measures, this study seems to be intent on the need to maintain high ethical standards, especially regarding the protection of the rights and welfare of participants.
Data Analysis
The data analysis process in this study employs the use of frequency and percentage distributions to analyze the data collected by the research questionnaires (Eren & Sahil, 2016). The various sets of criteria for evaluation of various data types acquired from the collection process are well geared towards the process of analysing this data to gain meaningful interpretation from it. Scales of measurement are set with respect to the expected total scores and the set standards of low or high measures. In the independent questionnaire response analysis; the data analysis process in this study allows for the estimation of either less difficult or most difficult estimations, based on the scale specifications of the PD-DWS scale. Equally, scale specifications on the PD-APS scale further provide set estimations for either negative attitudes or positive attitudes towards persons with PDs among MHWs.
To enhance the credibility of the study results, the researcher uses various hypothesis testing measures to ensure that test scores are normal and efficient. In this study, the main issues of concern were the attitudes of the MHWs towards persons with PDs and the difficulties they experience in the process of attending to these patients. The Shapiro–Wilk test method was used to gauge the sensitivity of the respondents with regard to their difficulty and attitude levels based on the available data. The Shapiro–Wilk test method was used to develop the best possible hypotheses, the study also used the group t-tests to evaluate the variance of the results by use of the ANOVA method (Eren, 2014). This method was employed in instances of the independent variables falling between two groups. However, to cater for the needs of continuous variables, the Pearson Correlation coefficient method was used. The use of the Statistical Package for the Social Sciences (SPSS), 15th version was also a critical data analysis tool that was bound to enhance the credibility of the study’s findings. This suggests that the use of independent and accuracy sensitive methods render the study findings credible. It is difficult to disqualify the accuracy levels of the data analysis process employed in this research study, as it remains extremely self-explanatory.
Major Findings
The major themes outlined in the study findings are emotional reactions, difficulties experienced, MHW attitudes and their relationships to the scales of measurement. In the emotional reactions evaluation, the study observes that MHWs who have the problems of boredom and pity are the ones who suffer the highest difficulty levels in handling persons with PDs. At the same time, the researchers also noted that these same health workers exhibited the most positive attitudes on the attitudes measurement scale. In the difficulty experienced theme, the study observes that the MHWs had a lot of difficulties in handling persons suffering from PDs, especially those in more severe disorder clusters such as antisocial, narcissistic and borderline disorders.
In the order of difficulty experienced per professional group, the researchers note that the nurses and psychiatric workers were the ones who experienced the highest number of difficulties, closely followed by the psychiatric nurses, and then the psychologists and psychiatrists who follow in the same order. The relationship between the two measurement scales of PD-DWS and PD-APS is that they are interlinked. Through these scale measurements, the positive attitudes development towards people suffering from PDs is also reflective of high difficulty encountered in addressing the plight of PD patients. Thus, this means that the communication of one scale has an impact on the interpretation of the other, hence their interrelation.
The study comprehensively concludes that the level of difficulty and the feelings experienced among MHW’s affect their attitudes towards persons suffering from PDs. The education and psychotherapy levels of the MHWs also influence their attitudes with increased education demonstrating more positive attitudes among nurses. The study additionally observes that staff support programs should be initiated to help reduce instances of burnout among nurses that can lead to the deterioration of their attitudes towards PD patients.
The data analysis process and its findings largely formed part of the researchers’ conclusions, providing a strong foundation for argument. The data collection and analysis instruments were highly reliable, providing a great basis for conclusion. The main study limitations of the researchers are their inability to sketch the causal relationships of the difficulties and attitudes that the MHWs experience in their line of duty. The study is nevertheless bound to give a true reflection of the state of health treatment to persons with PDs in addition to outlining the welfare of the MHWs. The study will therefore form a strong basis for Evidence Based Practice (EBP) and is set to have a huge impact on addressing the plight of the MHWs in their line of duty whilst at the same time, serving patients with PDs throughout Turkey.
Conclusion
The study provides a detailed overview of the experiences of various MHWs during their course of duty whilst addressing the health care needs of the persons with PDs. The study sample is representative of the target population although the sample size is not deemed large enough for the number of people it represents throughout the various regions of Turkey. The study uses reliable means of data collection and analysis, resulting in convincingly sound findings that are reflective of the actual situation at various health facilities. The themes under reflection in the study are also well analyzed through this critique process although I observed that the study fails to pinpoint the causal relationships of the various findings. Through this study, I learnt that the MHWs can be assisted in controlling their attitudes and difficulties towards persons with PDs through training in psychotherapy, and by receiving additional education and training in nursing practice for mental health care. This is in addition to work support mechanisms, and I am of the opinion that all MHWs should continuously undergo routine training to enhance service delivery to PD patients. In addition, systems should be developed to ensure that MHWs are no longer overworked, a situation which could only result in difficulties in tending to the needs of the PD patients. The study has further brought to my attention the fact that research and Evidence Based Practice are inextricably linked since they both depend on each other to provide comprehensive information regarding various detrimental healthcare practices and the possible solutions thereto.
References
Chugani, C. D. (2016). Recovered Voices: Experiences of Borderline Personality Disorder. The
Qualitative Report, 21(6), 1016-1034.
Black, D. W., Pfohl, B., Blum, N., McCormick, B., Allen, J., North, C. S., … & Williams, J. B. (2011). Attitudes toward borderline personality disorder: a survey of 706 mental health clinicians. CNS spectrums, 16(03), 67-74.
Eren, N., & Şahin, S. (2016). An evaluation of the difficulties and attitudes mental health professionals experience with people with personality disorders. Journal of psychiatric and mental health nursing, 23(1), 22-36.
Nurhan, E. R. E. N. (2014). Psychometric properties of difficulties of working with patients with personality disorders and attitudes towards patients with personality disorders scales. Archives of Neuropsychiatry, 51, 318-327. doi: 10.4274/npa.y7056.
Hyett, N., Kenny, A., & Dickson-Swift, V. (2014). Methodology or method? A critical review of qualitative case study reports. International Journal of Qualitative Studies on Health and Well-Being, 9, 10.3402/qhw.v9.23606.
