A Qualitative Exploration of Trainee Nurse Practitioners' Experiences and Readiness to Provide Care for Borderline Personality Disorder in Primary Care

Abstract

To explore trainee Advanced Nurse Practitioners' clinical experience and professional preparedness in managing personality disorder presentations within primary care. A qualitative descriptive study using semi-structured interviews and inductive thematic analysis. Between July and December 2024, 10 trainees enrolled at Ulster University completed online semi-structured interviews. Data were analysed using Braun and Clarke's reflective thematic analysis framework, with rigour enhanced through triangulation. Four themes emerged: perceptions of patient attendance and engagement, workplace challenges, reflections on clinical experience and educational readiness. Participants described feeling underprepared for consultations, particularly around assessment, diagnosis and intervention. Limited training, time constraints, lack of clear pathways and systemic barriers were highlighted. Emotional strain and uncertainty often influenced clinical encounters. Participants emphasised the need for targeted continuing professional development, structured mentorship and crisis management training to build confidence and competence. Trainees face significant challenges in providing care for individuals with personality disorder in primary care. Missed opportunities in care were linked to limited training, systemic constraints and the emotional complexity of presentations. Strengthening psychiatric content in advanced practitioner curricula, alongside mentorship and organisational support, is essential for safe and effective practice. This study demonstrates the need for personality disorder-specific education, access to interdisciplinary mentorship and policy-level changes to support effective care in community settings. The study adhered to COREQ reporting guidelines. This study did not include patient or public involvement in its design, conduct or reporting.