• Wei-Fen Ma, Fu-Jin Shih, Szu-Mei Hsiao, Shaw-Nin Shih, and Mark Hayter.
• School of Nursing and Nursing Department, China Medical University and Hospital, Taichung, Taiwan.
• J Clin Nurs. 2009 Feb 1;18(3):440-50.

AimTo explore the contributing factors and effects of Taiwan's mental health nurses' decision-making patterns on care outcomes for patients with borderline personality disorder.BackgroundPatients with borderline personality disorder have been identified as difficult to care for. Taiwan's mental health nurses have complained about the lack of successful outcomes with existing care regimes, and few studies have explored these nurses' perceptions of how their decision-making process impacts quality of care for their clients.DesignDescriptive qualitative research.MethodsData collected through semi-structured, face-to-face, in-depth interviews were analysed by qualitative content analysis. Fifteen mental health nurses were purposively recruited from a psychiatric centre in northern Taiwan.ResultsThe informants' caring outcomes for borderline personality disorder patients were involved with interactions of the following five themes: (a) shifting from the honeymoon to chaos stage, (b) nurses' expectations for positive vs. negative outcomes, (c) practicing routine vs. individualised nursing care, (d) adequate or inadequate support from healthcare team members and (e) differences in care outcomes (satisfactory experiences, unsatisfactory experiences and superficial relationships). A conceptual framework of a 'two-stage care process' was developed to depict the relationships among these five themes with different care outcomes.ConclusionsAlthough Taiwan's mental health nurses reported more unsatisfactory than satisfactory care outcomes, more satisfactory patient outcomes might be obtained by nurses' positive attitudes, unrelenting efforts towards promoting the health of these patients and receiving timely and constant support from healthcare team members.Relevance To Clinical PracticeMental health nurses should not give up too readily on borderline personality disorder clients, but adopt a positive attitude and coach them in learning to relax and work with others. Nurses are encouraged to establish supportive team relationships to motivate each other to work for positive care outcomes, to better understand their clients' needs and to develop individualised in addition to routine care strategies.

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