Examples of Each Category of Concern
The following are examples and do not present an exhaustive list. You may be able to identify a broad range of examples to add to the lists below.
Definitions of therapeutic – “relating to the healing of disease,” “providing or assisting in a cure.” Again the context of the professional relationship is important – as per the definition this is a category of concern that relates specifically to clinicians – doctors, nurses, allied health. Being clear on one’s professional Code of Ethics, Scope of Practice, expectations of the professional role is essential to help guide the therapeutic relationship.
Consider how much information is required or example by a teacher to enable them to effectively teach students. Similarly, how much is required by a clinician to effectively provide care and treatment to patients? This is another area of boundaries where context is important.
Is it possible that all that is required from the nurse to the patient is their name, level of nurse, and that they will be providing care for that patient for that shift? Is there a requirement to disclose further information? If so, how much would be too much? What measure does the professional use to gauge how much is too much?
There are areas of personal disclosure from professional to client that are considered boundary transgressions for example – disclosing information about personal problems (financial, intimate, workplace bullying), personal history especially if the disclosure is about abuse.
One point to consider here – what was the context of the original relationship? For example:
Scenario One – the initial relationship is nurse and patient (and then a friendship develops) – dual relationship. Thus the initial relationship would have been a nurse in position of power with the vulnerable patient.
Scenario Two – two people are friendly neighbours one is a nurse and then the other is admitted to hospital for care. So the initial relationship is more mutual than the first example and then the dynamics change.
Considering scenario two what can the nurse do / say to ensure that he / she maintains boundaries when their neighbour is admitted to the hospital they work in?
Examples of maintaining boundaries in dual/multi relationships:
If possible have no involvement in the care of their neighbour, do not access the progress notes of their neighbour if not nursing them, inform supervisors of the initial relationship, be clear with their neighbour (if they are involved in their care) that they will maintain confidentiality, and that the relationship will be a professional one not a personal or neighbourly one.
- Gifts such as flowers, chocolates, paintings, bottles of wine, fruit, home baking, lotto tickets, movie tickets.
- Services such as babysitting, lawn mowing, landscaping, car repairs, house painting, landscaping.
- Money such as cash, being left money in wills, cheques, bonds.