Week 10 - Establishing, maintaining, and navigating boundaries in the therapeutic relationship

Question 1

Distinct from other types of relationships due to the inherent power differential that exists between a client and a practitioner

Answer 1

therapeutic relationship

Question 2

Why is the NC therapeutic relationship asymmetrical?

Answer 2

the nurse has more knowledge and expertise
The client may be distressed
the client has to provide personal health information

Question 3

Relationship directed with advancing best interests of client, not best interest of professional

Answer 3

therapeutic relationships

Question 4

What are the key elements of therapeutic relationships?

Answer 4

Trust, respect, professional intimacy, empathy, power

Question 5

When the patient feels safe in sharing information and feels comfortable with us providing personal care to them

Answer 5

Professional intimacy

Question 6

Expression of understanding, validating and resonating with the client and how their HC experience affects them

Answer 6

empathy

Question 7

What are the RNAO BPGs regarding therapeutic relationships?

Answer 7

Knowledge
reflective practice/self-awareness
Understand the process of building relationships
Learn about therapeutic relationships in BScN
Ongoing professional development

Question 8

Connects with the concepts of consciousness and energy, while intentions remind us of what is important and informs our choices and actions

Answer 8

intentionality

Question 9

Having an ethical awareness of our actions, expectations and beliefs

Answer 9

Intentionality

Question 10

What are organizational factors that influence therapeutic relationships?

Answer 10

Staffing and workload
FT vs. PT and casual positions
Leadership
Supportive clinical supervision and coaching

Question 11

What does RNAO suggest for FT complement of nursing staff?

Answer 11

70% of employees should be FT

Question 12

Indicates what is “out of bounds” in relationships; acts to constrain, constrict and limit

Answer 12

boundary

Question 13

Edge of appropriate behaviour between TR and boundary violation

Answer 13

boundary

Question 14

Confusion between needs of nurse and client

Answer 14

boundary violation

Question 15

If the patient breaks the therapeutic relationships, who does the onus fall on?

Answer 15

the nurse

Question 16

What is the purpose of the boundary?

Answer 16

protects client from harm and protects the nurse/professional

Question 17

What are some factors that influence boundaries, briefly describe.

Answer 17

Need and personality of patient - e.g. some patients need more reassurance or may lack support outside the hospital

Character and training of the therapist - innate ability to connect with others/desire to push boundaries

Status of the treatment alliance - e.g. palliative vs. high turnover floor

Treatment setting - home care more intimate than hospital care

Geography - e.g. dual relationships in rural settings

Culture - different boundaries in different cultures

Question 18

if a nurse daydreams, fantasizes, or considers crossing a line, this is referred to as drifting over the line. The nurse may not have actually crossed a boundary behaviourally, but what one can fantasize may come true

Answer 18

boundary drift

Question 19

excursions across the lines demarcating the professional relationship

Answer 19

boundary crossings

Question 20

Crossing the boundary line in a way that is clearly harmful or exploitive; often puts the professional’s needs ahead of the client’s

Answer 20

boundary violations

Question 21

Identify whether the example is a boundary crossing or violation.

A - Therapist provides a sweatshirt to a client to help motivate them

B - George Harrison’s doctor coerced him into autographing a guitar

C - Anything of a sexual nature

D - taking a patient down to the cafeteria because they like the food

E - giving and receiving gifts

F - financial involvement

G - improper social involvement

Answer 21

A - boundary crossing
B - boundary violation
C - violation
D - crossing
E - violation
F - Violation
G - violation

Question 22

What is the most common non-sexual boundary violation?

Answer 22

Improper social involvement

Question 23

Describe the slippery slope argument.

Answer 23

More personal disclosures often lead to progressively worse boundary crossing, until boundary violation occurs

Question 24

Describe accepting gifts.

Answer 24

Do not accept individual gifts unless refusal would harm the NC relationship
- accept team gifts if possible

Question 25

Describe giving gifts.

Answer 25

If giving gifts, ensure that the client is aware that reciprocity is not expected and that the relationship will not change as a result of gift giving

Question 26

Describe reporting and client abuse.

Answer 26

If another nurse is abusing a patient, must report to employer (not necessarily to college)
Must report sexual abuse to college (even if only suspected)
Must report child abuse to CAS (even if only suspected)

Question 27

How long does a nurse have to wait after the termination of the NC therapeutic relationship to engage in a non-professional relationship with a client?

Answer 27

1 year