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Nurses use professional judgment to determine the appropriate boundaries of a therapeutic Nurse-client relationships are therapeutic, focus on client needs and are defined by professional boundaries. . Boundary crossings and violations. Nov 30, But in some cases, the nurse-patient relationship develops into a The NCSBN defines a boundary crossing as a decision to deviate from an. of a therapeutic nurse-client relationship (Appendix E);. ensures that any approach or activity that could be perceived as a boundary crossing is included in.
Some who violate boundaries may also have preexisting or underlying personal issues, such as substance abuse. Significant and emotional life events can pose risks for patients as they become vulnerable to compassionate feedback and seek to connect with others who can empathize with them.
Recognizing warning signs Signs of inappropriate behavior can be subtle at first. Early signs might include spending more time with a patient, showing favoritism, or meeting a patient in areas besides those used to provide direct patient care.
They may show dependence on a particular staff member, frequently request the same caregiver, or ask other staff questions about the nurse. Confrontation and legalities The duty to address inappropriate relationships extends not only to the nurse directly involved, but also to nurses who are peers or managers of the involved nurse.
Civil actions can arise for battery or other harm suffered by the patient such as intentional infliction of emotional distress. A patient can initiate a civil or criminal lawsuit against a nurse even if the sexual involvement took place after the nurse-patient relationship ended.
Damages and legal representation fees may not be covered by professional liability insurance. Explain your actions and obtaining client consent before initiating any activities. Touch clients only in a manner consistent with accepted standards of nursing practice. Be aware of the potential impact of your manner of dress on your client s and dress in a manner that maintains professional boundaries.
Consider if a client-specific care plan related to professionally intimate activities would be helpful to ensure both client and staff safety. Boundary crossings and violations Boundary crossings Boundary crossings are brief excursions across professional lines of behavior that may be inadvertent, thoughtless or even purposeful, while attempting to meet a special therapeutic need of the client.
Some individual behaviours may appear harmless but when put together, form a pattern indicating a boundary has been crossed. Examples of boundary crossings: Driving a client to do their banking because you were going that way. Boundary violations Boundary violations can result when there is confusion between the needs of the nurse and those of the client.
Don't cross the line: respecting professional boundaries.
Inappropriate relationships may start with something benign then gradually progress until the nurse has clearly violated a boundary. Examples of boundary violations: Visiting with a client when not at work Asking your client, the accountant, the best way to invest money Referring your client for foot care but only providing your own business card Professional sexual misconduct is an extreme form of boundary violation and includes any behavior that is seductive, sexually demeaning, harassing or reasonably interpreted as sexual by the patient e.
It is a breach of trust. Warning signs of boundary issues The following behaviours can signal potential boundary issues. These signs indicate a need to reflect on the nurse-client relationship and clarify boundaries. Giving preferential care or time to the client and putting their care needs above others. Having more physical contact than is required or appropriate.
Spending breaks or time off with the client, seeking social contact and providing personal information such as your email address or phone number. Participating in personal conversations, flirtations, off-color jokes or sexual innuendos. Feeling a sense of excitement, longing, romantic or sexual thoughts related to the client.
Hiding your relationship with the client from others. Receiving feedback from others that your behaviour is overly familiar or intrusive. Refusing to transfer care of a client to another provider when therapeutically indicated.
Under involvement with a client Delaying care or treatment e. Blaming the client for lack of progress. Being unnecessarily rough when providing care. Using disrespectful, demeaning, insulting, or humiliating language or tone.
Inadequately draping a client during a procedure Avoiding the client to a degree that interferes meeting care needs. Nurses disclose a limited amount of information about themselves only after they determine it may help to meet the therapeutic needs of the client. Nurses may touch or hug a client with a supportive and therapeutic intent and with the implicit or explicit consent of the client.
Nurses do not communicate with or about clients in ways that may be perceived as demeaning, seductive, insulting, disrespectful, or humiliating. This is unacceptable behaviour. Nurses do not engage in any activity that results in inappropriate financial or personal benefit to themselves or loss to the client.
Nurses do not act as representatives for clients under powers of attorney or representation agreements. Generally, nurses do not exchange gifts with clients. Where it has therapeutic intent, a group of nurses may give or receive a token gift.
Nurses return or redirect any significant gift. Nurses do not accept a bequest from a client. Applying the principles to practice Be transparent, therapeutic and ethical with all your clients and former clients. When the issues are complex and boundaries are not clear, discuss your concerns with a knowledgeable and trusted colleague.
Disclose your personal information only with a therapeutic intent, such as to develop trust and establish a rapport with a client.
Boundaries in the Nurse-Client Relationship
Do not disclose intimate details or give long descriptions of your personal experience. Recognize that if you accept clients as personal contacts on social media sites, you may be crossing a boundary. You may also breach client privacy and confidentiality. Do not discuss clients even anonymously or indirectly or share client pictures on social media sites or in any public forum.
Understand that nurses who work and live in the same community often have a dual role. If you have a personal relationship with a client or former client, be clear about when you are acting in a personal relationship and when you are acting in a professional relationship. Explain your commitment to confidentiality and what the client can expect of you as a nurse. Consider the difference between being friendly and being friends.