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Maintaining Professional Boundaries in Nursing

Part III:  Is what I am saying or doing promoting the patient’s ability to care for themselves?

Intorduction: 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.

Autonomy- “self-law”.  Ensure that what you are saying or doing helps the patient maintain or make steps toward autonomy. Autonomy is an ethical concept which reflects the patient’s right to control their life.  Autonomy, competence and relatedness are considered the basis for the human need of self-determination. Providing too much care, or doing for a patient what the patient is capable of doing can unknowingly undermine the patient’s self-concept, and ultimately, blunt the patient’s inherent motivation to be independent. How can you care AND promote self-determination?

Ask yourself: What can I do to help the patient help themselves? Can the patient make that phone call to arrange a service?  Does the patient need to have you attend all appointments with providers?  Can the patient safely ambulate to the toilet rather than using the bedpan?  Can the patient express what their care goals are?

Danger signs that professional boundaries have been crossed:

  1. The nurse or the patient believes that they are the only one that can care for the patient
  2. The nurse flirts with the patient
  3. The nurse is doing something for the patient that the patient could do for his or herself
  4. The nurse shares intimate or personal details
  5. Speaking poorly about co-workers or the place of care

 

“This is what it means to have autonomy — you may not control life’s circumstances, but getting to be the author of your life means getting to control what you do with them.”  Atul Gawande


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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2 Comments

  1. Doctor Jonathan

    Boundaries are often crossed; sometimes with good intentions and sometimes with bad intentions. There are certainly grey areas, but when in doubt, ASK someone RESPONSIBLE and IN CHARGE.

    I don’t doubt that many GOOD qualified health care professionals will overstep boundaries based on moral and ethical convictions. The ramifications can still range from “minor” scolding to removal from position. I am a strong believer in following one’s ethical and moral beliefs, but one must understand the potential consequences ahead of time. Is it worth losing one’s job? In some cases, I’m certain the answer is “YES!”

    Liked by 1 person

  2. NurSerial

    Dr. Jonathan, Thank you for your considered reply. I posted this discussion regarding professional boundaries principally as a personal refresher. Nursing school was a while ago, and somehow, in the 20+ years I have worked, the topic doesn’t seem to get discussed in practice. Your advice is great- -if you feel uncomfortable or uncertain about a patient relationship, ask a preceptor, your manager, your mentor for advice.

    Like

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