Boundaries Flashcards
Professional boundaries
Limits that protect the space between the professional’s power and the client’s vulnerability
Why are boundaries important in nursing
Nurses can play a significant role in others lives
Intimacy of caring actions
Humanizing institutional environments
Potential for long-term relationships
Care provided in homes and other less formal settings
Boundary dilemmas
Conflict of interest between professional and personal aspects of relationships
Longer-term relationships with clients- spinal cord injuries, burn patients, home visits
Power differentials between clients and professionals
Rural and remote practice - dual and overlapping relationships
Culturally sensitive approaches to boundaries
Establishing guidelines
Codes of ethics and agent policies - clear lines to be drawn between professional and client
Unique aspects of each professional client relationship
Critical consideration of the complexity of a situation
Entangled
Consistent over involvement
Invest more time, emotional energy or favour in one relationship more than another
Unhelpful to client
Meeting own emotional, social, or physical needs at the expense of the client
Level of feeling of responsibility is out of proportion- feels more concerned than the family members do
Rigid
Inflexible, condescending, in meeting own agenda
Does not attend to unique and multifaceted needs of the client
Lack of authenticity and sensitivity
Exploits clients vulnerabilities
Accentuates power differentials
Lack of concern, compassion and responsibility for working toward change with the family
Balanced
Authentic and caring with clear boundaries
Use professional judgement and self-reflection
Aware of position of power, uses authority appropriately
Professionally responsible and accountable
Attends to clients unique needs
Maintains distinctions of their professional role in the relationship
Influencing factors
Family practices Gender Culture Religion Age
Boundary crossing vs. Violation
Crossing = outside commonly accepted standards of behaviour in exceptional circumstances, not harmful to client Violation = uses relationship to meet own personal needs, harmful to client
Self-disclosure
Professional background and experience- particularly in relation to the family’s concerns Reciprocal relationship Facilitating engagement Equalizing power Purposeful - deliberate professional action Normalizing experiences and feelings Communicate hope Find areas of common interest
Dangers to self-disclosure
Unloading your personal baggage- burdening the family
Minimizing the family’s experiences- each is unique
Being seen as a “friend”, social not professional interactions
Boundary strategies
Acknowledge the possibilities Self-awareness and self-monitoring Peer debriefing Clinical supervision- not direct supervisor Meaningful practice guidelines Education and continuing education
Best practice for home visits
Employee training
Effective communication systems
Hazard assessment (safety awareness checklist, evaluate risk)
Safe visit plan (active communication plan, switch meeting place, use two employees)
Home visiting safety and community health nurses
Community-based nurses practice in uncertain, uncontrollable, and unpredictable work environments
Minimize known risk, recognize and evaluate unforeseen risks, be prepared to take strategic action
Underestimating risks is a threat to safety
Be prepared
Personal preparation Agency preparation Vehicle preparation Environmental surveillance Response to situations
