Week 10 - Establishing, maintaining, and navigating boundaries in the therapeutic relationship Flashcards
Distinct from other types of relationships due to the inherent power differential that exists between a client and a practitioner
therapeutic relationship
Why is the NC therapeutic relationship asymmetrical?
the nurse has more knowledge and expertise
The client may be distressed
the client has to provide personal health information
Relationship directed with advancing best interests of client, not best interest of professional
therapeutic relationships
What are the key elements of therapeutic relationships?
Trust, respect, professional intimacy, empathy, power
When the patient feels safe in sharing information and feels comfortable with us providing personal care to them
Professional intimacy
Expression of understanding, validating and resonating with the client and how their HC experience affects them
empathy
What are the RNAO BPGs regarding therapeutic relationships?
Knowledge
reflective practice/self-awareness
Understand the process of building relationships
Learn about therapeutic relationships in BScN
Ongoing professional development
Connects with the concepts of consciousness and energy, while intentions remind us of what is important and informs our choices and actions
intentionality
Having an ethical awareness of our actions, expectations and beliefs
Intentionality
What are organizational factors that influence therapeutic relationships?
Staffing and workload
FT vs. PT and casual positions
Leadership
Supportive clinical supervision and coaching
What does RNAO suggest for FT complement of nursing staff?
70% of employees should be FT
Indicates what is “out of bounds” in relationships; acts to constrain, constrict and limit
boundary
Edge of appropriate behaviour between TR and boundary violation
boundary
Confusion between needs of nurse and client
boundary violation
If the patient breaks the therapeutic relationships, who does the onus fall on?
the nurse
What is the purpose of the boundary?
protects client from harm and protects the nurse/professional
What are some factors that influence boundaries, briefly describe.
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
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
boundary drift
excursions across the lines demarcating the professional relationship
boundary crossings
Crossing the boundary line in a way that is clearly harmful or exploitive; often puts the professional’s needs ahead of the client’s
boundary violations
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 - boundary crossing B - boundary violation C - violation D - crossing E - violation F - Violation G - violation
What is the most common non-sexual boundary violation?
Improper social involvement
Describe the slippery slope argument.
More personal disclosures often lead to progressively worse boundary crossing, until boundary violation occurs
Describe accepting gifts.
Do not accept individual gifts unless refusal would harm the NC relationship
- accept team gifts if possible
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
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)
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
