Nursing interventions in personality disorders in the field of primary care

For nursing students

Study summary

This article, published in the International Journal of Developmental and Educational Psychology (INFAD) in 2017, is a literature review that asks a practical question: what role should nurses play when a patient has a personality disorder, especially in a primary care setting? The authors, Crescencio Pérez Murillo, Gonzalo Moreno Tobías, and Simón Iruela Sánchez, define personality disorders using the American Psychiatric Association (APA) framework: personality disorders are patterns of emotional and behavioral signs that disrupt a person's social adaptation and diverge from what their culture expects of them.

To answer their question, the authors searched the PUBMED and SCIELO databases in January and February of 2017, using the search terms "personality disorder," "nursing care," "personality," and "primary care." This is not a clinical trial or a study with patients directly; it is a review that pulls together existing literature to describe how nursing care for personality disorders should be organized.

The central finding is that nursing care should be tailored to two very different clinical pictures. When a patient is in crisis, the nurse's first job is to assess vital risk and the degree of aggressiveness present, and to arrange an evaluation by psychology. Safety comes first, and the nurse works in coordination with mental health specialists rather than trying to manage the crisis alone.

When a patient is stable, the nursing role changes considerably. In this scenario, the review found that a more extensive assessment process is appropriate, one that goes beyond immediate risk and looks at the patient's overall functioning. From that assessment, nursing interventions are aimed at helping the patient make changes to their lifestyle, changes that support long-term stability rather than just managing an acute episode.

The authors conclude that the primary care nursing consultation has real value for these patients, but specifically for those who are emotionally stable rather than in active crisis. In that stable population, nursing consultations can help patients solve day-to-day problems and complications related to their disorder. The review also states that this kind of nursing care supports the development of effective coping strategies and helps to reduce anxiety. The authors frame this as an opening: new strategies and intervention possibilities become available to nursing professionals as they try to meet these patients' emotional and therapeutic needs.

For nursing students, this article is a useful reminder that personality disorders are not a single, uniform diagnosis that calls for one script of nursing care. The clinical picture, whether the person is in crisis or stable, should drive what the nurse does next. In a crisis, a nurse's core responsibility is a fast, careful risk assessment and a clear pathway to psychology, not a long counseling conversation. In a stable patient, the nurse has more room to build a relationship, assess more broadly, and support lifestyle change and coping skills over time.

It's important to be precise about what this article actually is: a narrative literature review of prior published work, not a new clinical study with its own patient sample. That means its "findings" are really a synthesis of what other researchers have already reported, filtered through the authors' reading of the PUBMED and SCIELO literature from two specific months in 2017. The review does not report how many articles were included, does not describe formal inclusion or exclusion criteria, and does not report specific outcome data such as symptom scores or anxiety measures. Readers should treat its conclusions as a broad orientation to the field rather than as evidence from a single controlled study.

Because the original article was published in Spanish, and the version consulted here draws on the English-language abstract, some nuance from the full Spanish text may not be reflected in this summary. Still, the core message is clear and clinically sensible: nurses in primary care need two different skill sets when working with people who have personality disorders — crisis assessment and referral on one hand, and longer-term, lifestyle-oriented, relationship-based care on the other.

For educators

Teaching and appraisal notes

This paper, "Intervenciones de enfermería en los trastornos de la personalidad en el ámbito de la atención primaria" (Nursing interventions in personality disorders in the field of primary care), was published in Volume 4, No. 1 (2017) of the International Journal of Developmental and Educational Psychology (INFAD), pages 203-214, by Crescencio Pérez Murillo (Servicio Aragonés de Salud) together with Gonzalo Moreno Tobías and Simón Iruela Sánchez (Universidad de Almería). It is best used in the classroom as an example of a narrative literature review rather than as primary research evidence.

The stated objective was to identify and determine the role of nursing care in personality disorders. The authors' method was a literature search of PUBMED and SCIELO conducted in January-February 2017 using the terms "personality disorder," "nursing care," "personality," and "primary care." No systematic review protocol (e.g., PRISMA), formal quality appraisal, or reported number of included studies is described in the abstract, which is an important teaching point: this is a narrative synthesis, and its conclusions should be weighted accordingly when used to guide practice.

The review's central organizing idea is a two-track model of nursing care based on patient state. In crisis, the priority is safety: assessing vital risk and level of aggressiveness, followed by referral for psychological evaluation. In a stable patient, the nursing role shifts toward a broader, more extensive assessment, with interventions oriented toward lifestyle change. The authors conclude that primary care nursing consultation is particularly valuable for stable patients, helping them resolve problems and complications associated with their disorder, supporting effective coping strategies, and reducing anxiety. They frame this as opening new intervention possibilities for nurses seeking to meet patients' emotional and therapeutic needs.

For instructors, this article works well as a discussion vehicle for several core competencies: differentiating crisis versus stable presentations in mental health nursing, the appropriate scope of primary care nursing versus specialist mental health referral, and the limits of narrative reviews as evidence. Students can be asked to compare this two-track model against more structured frameworks, such as DSM-5/ICD-11 personality disorder classifications or crisis intervention models taught elsewhere in the curriculum, to see where this review's framing is consistent with, or thinner than, more rigorous sources.

Faculty should be transparent with students that the abstract, the only portion reliably available for this synthesis, does not report a sample size, inclusion/exclusion criteria, number of studies reviewed, or specific outcome statistics. It also does not specify whether "primary care" refers to a particular national health system context (the authors' affiliations suggest a Spanish setting, via Servicio Aragonés de Salud), which limits how directly its conclusions transfer to a Canadian primary care context. The original article is in Spanish; this synthesis relies on the English-language abstract, so some methodological detail available only in the full Spanish text is not reflected here.

Suggested classroom use: pair this review with a current clinical practice guideline on personality disorders and ask students to identify what a narrative review like this one adds, and what it cannot substitute for, when planning nursing care.