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

1
Q

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

A

therapeutic relationship

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2
Q

Why is the NC therapeutic relationship asymmetrical?

A

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

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3
Q

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

A

therapeutic relationships

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4
Q

What are the key elements of therapeutic relationships?

A

Trust, respect, professional intimacy, empathy, power

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5
Q

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

A

Professional intimacy

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6
Q

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

A

empathy

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7
Q

What are the RNAO BPGs regarding therapeutic relationships?

A

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

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8
Q

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

A

intentionality

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9
Q

Having an ethical awareness of our actions, expectations and beliefs

A

Intentionality

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10
Q

What are organizational factors that influence therapeutic relationships?

A

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

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11
Q

What does RNAO suggest for FT complement of nursing staff?

A

70% of employees should be FT

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12
Q

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

A

boundary

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13
Q

Edge of appropriate behaviour between TR and boundary violation

A

boundary

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14
Q

Confusion between needs of nurse and client

A

boundary violation

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15
Q

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

A

the nurse

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16
Q

What is the purpose of the boundary?

A

protects client from harm and protects the nurse/professional

17
Q

What are some factors that influence boundaries, briefly describe.

A

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

18
Q

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

A

boundary drift

19
Q

excursions across the lines demarcating the professional relationship

A

boundary crossings

20
Q

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

A

boundary violations

21
Q

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

A
A - boundary crossing
B - boundary violation
C - violation
D - crossing
E - violation
F - Violation
G - violation
22
Q

What is the most common non-sexual boundary violation?

A

Improper social involvement

23
Q

Describe the slippery slope argument.

A

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

24
Q

Describe accepting gifts.

A

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

25
Describe giving gifts.
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
26
Describe reporting and client abuse.
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)
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?
1 year