Abstract

In lieu of an abstract, here is a brief excerpt of the content:Every Patient is a Teacher—Especially the "Difficult" Ones:Caring for Patients with Borderline Personality DisorderCara ConnaughtonNo one can teach you how to work with a patient living with borderline personality disorder quite like a patient living with borderline personality disorder (BPD). The lesson [End Page E9] isn't on how to be the perfect caregiver or how to meet all the patient's needs. The lesson is to notice that the quality of care and the patient's response are not always mutually dependent and that holding ourselves to impossible standards will only lead to resentment, job dissatisfaction, and potentially burnout.I had a very good teacher on this subject and her name was Sandra.1 Sandra was admitted to our hospital unit with end stage cervical cancer. She had attempted to treat her illness by using only homeopathic remedies, which hadn't abated the disease. While at the hospital, Sandra was intensely controlling over her medications as well as when and how she took them. Sandra had also been diagnosed with BPD. One symptom of her disorder manifested in staff splitting: she saw staff members as either good or bad and treated them as such—her thinking was very black and white. She would talk very badly about other nurses to the current nurse working or talk very well about her favorite nurse in a way that made me and other nurses feel that we weren't measuring up. Sandra also exhibited intense anger toward most staff and had unexpected mood swings—I didn't know what I was going to get when I walked into her room but was fairly certain it would include berating and belittling comments. This same treatment was given to most staff nurses except for one. Sandra's favorite nurse was Bonnie; Bonnie couldn't understand why the rest of the nursing staff found Sandra difficult since she was always treated very well by this patient.I dreaded coming to work to find Sandra as part of my patient assignment for the day. I knew that day would be full of cutting remarks and disappointment from Sandra, no matter how hard I tried to provide compassionate and quality care. Further, trying to meet her seemingly endless needs took away from the care that I could provide for the other patients on my assignment. I could easily spend an hour in Sandra's room doing various tasks while she expressed frustration and anger toward me—I couldn't seem to do anything right.I have cared for many "difficult" patients throughout my years as a bedside nurse—including those who were physically and verbally aggressive—but Sandra always stands out as the most "difficult" because her words and behavior cut right through me. Even the briefest interactions with Sandra left me questioning my competence as a nurse, something I hadn't experienced when caring for other "difficult" patients.A turning point in how I related to Sandra's behavior occurred one day shift when she was part of my patient assignment. Sandra had been off the unit for a treatment from before I'd even started my shift at 7 am. At 11 am, Sandra arrived back on the unit. A few minutes later, I brought her 9 am medications to her room. The medications were technically late, but of course, it would have been impossible for me to bring them to her on time as she wasn't even present on the unit. She said angrily, "These are late! Bonnie never brings my medications late!" At that moment, something switched in my mind—it wasn't me! What a relief. I had to let go of the idea that I needed to make this patient happy in order to be a good nurse. Prior to this incident, I determined how good of a job I was doing based on how happy my patient appeared with their care. I realized that a patient's satisfaction wasn't always dependent on the quality of the care I provided.All of us provided the best care that we could for Sandra. To help us do this while maintaining our own mental wellness, we rotated...