Professional Boundaries

1
Professional Boundaries

• Mental Health Psychiatric Care

2
Continuum of Professional Behavior
Under-involvement cold, distant Zone of helpfulness Over-involvement boundary problems
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What are Personal Boundaries?

• A dynamic line separating an individuals
  internal and external environment, which varies
  in permeability and flexibility (Scott, 1988)
• Includes
• Physical
• Emotional
• Intellectual
• Spiritual

4
Professional Boundaries

• The limits that allow a patient and nurse to
  connect safely in a therapeutic relationship
  based on the patients needs (Smith et al, 1997).

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Appropriate/Therapeutic Staff/Patient Interactions

• Potentially helpful
• Based upon the planned treatment of the patient
• Open for discussion with patients treatment team
• Intended to meet the therapeutic needs of the
  patient not the personal needs of the staff

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Boundary Violations

• The phenomena that occur when there is confusion
  of the professionals needs with the clients
  needs (National Council of State Boards of
  Nursing, 1996).
• Behavior that harms the patient (usually by
  exploitation) and places the therapists needs
  ahead of the patients (Gutheil, 1994).

7
Inappropriate/Non-therapeutic Staff/Patient
Interactions

• Potentially harmful
• Compromise a patients treatment plan
• Violate policy, ethics and possibly the law
• Are hidden from other staff or from the patients
  treatment team
• May evolve into dual relationships where the
  staff member exploits the patient for personal
  gain.

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Dual Relationships

• Two things going on at once
• 1. care-giver role
• 2. something other than care-giver role
• Unless the care plan specifically prescribes it
  staff should not engage in seemingly harmless
  activities.

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Harmless Activities

• Seeking help from patients
• Social conversation
• Sharing books or music
• Computer repair
• Poetry and prose editing
• Art criticism or art work commision
• Philosophical debate
• Spiritual counseling

10
Dual Relationships

• Do not happen overnight.
• They are the endpoint on an escalating continuum
  of boundary problems.

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Boundary Problems Continuum
Boundary Inattention Boundary Crossing Boundary Violation Dual Relationship
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Boundary Inattention

• Behaviors that suggest a staff member is
  oblivious to the setting
• Excessive social interaction with patients
• Cavalier with physical distance
• A comrade style (e.g. sports buddies)
• Misjudging cold threats
• Open with information
• Casual with dress code standards

13
Boundary Crossing

• Behaviors that are on the verge of, or may lead
  to, rule breaking.
• Sharing excessive personal information with
  patients
• Non sexual touching
• Confiding in and seeking comfort from patients
• Too close emotionally

14
Boundary Violation

• Behaviors that break hospital policy, breach
  professional ethics and/or break the law.
• Gift giving
• Bringing in food for one or more patients without
  treatment team permission
• Making non-treatment related phone calls or
  contacts for patient

15
Dual Relationship

• Interactions that are outside of the therapeutic
  boundaries that are for the personal
  gratification of the staff, and are either
  unethical, exploitive, and/or illegal.
• Sexual relationship
• Business relationship
• Religious counseling by non-clergy staff