Professional Boundaries

1. Professional Boundaries Mental Health Psychiatric Care

2. Continuum of Professional Behavior

3. What are Personal Boundaries? A dynamic line separating an individual’s 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 patient’s needs (Smith et al, 1997).

5. Appropriate/Therapeutic Staff/Patient Interactions • Potentially helpful • Based upon the planned treatment of the patient • Open for discussion with patient’s treatment team • Intended to meet the therapeutic needs of the patient not the personal needs of the staff

6. Boundary Violations • The phenomena that occur when there is confusion of the professional’s needs with the client’s needs (National Council of State Boards of Nursing, 1996). • Behavior that harms the patient (usually by exploitation) and places the therapist’s needs ahead of the patient’s (Gutheil, 1994).

7. Inappropriate/Non-therapeutic Staff/Patient Interactions • Potentially harmful • Compromise a patient’s treatment plan • Violate policy, ethics and possibly the law • Are hidden from other staff or from the patient’s treatment team • May evolve into dual relationships where the staff member exploits the patient for personal gain.

8. 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.

9. “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.

11. Boundary Problems Continuum

12. 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