Fast Fix: Care with a plan.

Professional boundaries in the nurse/patient relationship. Part II.
 Is what I am saying or doing helpful to the patient?

Introduction: Nurses are responsible to maintain healthy professional boundaries to protect the vulnerable healthcare services seeker.
The National Council of State Boards of Nursing defines professional boundaries as “spaces between the nurse’s power and the patient’s vulnerability. The power of the nurse comes from the nurse’s professional position and access to sensitive personal information.

Doing good by the patient.
Nursing care exists to ensure that the patient returns to, maintains or achieves a state of health.  The Stanford Encyclopedia of Philosophy states that healthcare has long been guided by beneficence, the ethical principal of “doing good” or  weighing the risks of treatment against potential benefit to the patient.  Nursing care should “do good”.

Studies show that nurses in hospital settings provide about 1 hour of direct care to each patient per day.  Make this time count!  Focus on the patient’s experience.  What is going well about their care?  What could be improved? What questions do they have?  Can you introduce more information which could help them better understand their condition?

But being friendly with the patient is doing good, right?  No reason you shouldn’t mention your bad day, right?   Maybe talk about your impending divorce, or how you had the same surgery and it was terrible?  This kind of talk isn’t good for the patient because it brings the focus back to you as the center of the conversation. It’s about your experience.

Focus on the patient’s experience.

 Not sure that what you are saying or doing is helpful to the patient?  The Nursing Council of New Zealand suggests that boundaries can be better maintained when the patient and nurse create—and stick to—a nursing plan of care.  Many nursing care plan resources exist which can help to provide the basis to evidence-based, beneficial patient care. Refer to publisher’s websites such as Lippincott or Elsevier for starters.

Questions a nurse could consider include: Is the care I am providing doing the patient good?  Does this care do harm? Is this information pertinent to the care being provided? How does this information relate to following the patient’s plan of care?

Look for “How much is too much caring-Part III” from NurSerial.


For more information about how to maintain nursing professional boundaries:
Professional Boundaries and the Nurse-client relationship: Keeping it safe and therapeutic, a publication by the College of Registered Nurses of Nova Scotia
Nurses Guide to Professional Boundaries published by the National Council of State Boards of Nursing
Guidelines: Professional Boundaries by the Nursing Council of New Zealand

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