Maintaining Professional Boundaries in •

Nursing
A continuum of professional behaviour
•Every nurse–patient relationship can be conceptualized on
the continuum of professional behavior. Nurses can use this
graphic as a frame of reference to evaluate their behavior
and consider if they are acting within the confines of the
therapeutic relationship or if they are underinvloved or
overinvolved in their patients’ care.
 A therapeutic relationship
:
• A therapeutic relationship is one that allows nurses to apply
their professional knowledge, skills, abilities and experiences
towards meeting the health needs of the patient.
 :

The therapeutic nurse-client relationship

characterized by
 Trust and respect
 Protecting the client’s dignity, autonomy and privacy
irrespective of the context or duration of the
relationship.
 Purposeful and goal-directed relationships
• Over involvement includes boundary crossings, boundary
violations and professional sexual misconduct. Under
involvement includes patient abandonment, disinterest
and neglect, and can be detrimental to the patient and the
nurse. There are no definite lines separating the
therapeutic relationship from under involvement or
overinvolvement; instead, it is a gradual transition
 Professional Boundaries

•Professional boundaries are the defining lines which separate

the professional, therapeutic behaviour of a nurse from any
behaviour which, well intentioned or not, could harm or could
reduce the benefit of nursing care.
• When a nurse departs from the limits of a therapeutic
nurse-client relationship, intentionally or otherwise, it can
result in a boundary crossing or a boundary violation
•Boundary crossings are brief excursions (outing) across
professional lines of behavior that may be unintended,
thoughtless or even purposeful, while attempting to meet a special
therapeutic need of the patient. Boundary crossings can result in a
return to established boundaries, but should be evaluated by the
nurse for potential adverse patient consequences and implications.
Repeated boundary crossings should be avoided.
•establishing a personal relationships with clients;
•• use of social media with clients;
•• self-disclosure to clients;
•• accepting gifts from clients;
 Boundary violations
 Boundary violations occur when a nurse’s actions exploit
( abuse) the professional relationship to meet their own
personal need at the expense of the client. Boundary
violations are serious and often result in licensing
sanctions.
 Examples of boundary violations include:

 • Excessive self-disclosure about the nurse’s personal

situation;

 • Borrowing or attempting to borrow money;

 •Accepting a gift of money of significant value;

 • Gving a gift and expecting a favour in return;

 • Influencing a client to write or change their will or power of

attorney so the nurse will benefit;
• • Becoming emotionally involved in the client’s personal
relationships;
•• Selling products to clients that promote the nurse’s
personal business
•The nurse must always maintain professional boundaries
with patients and colleagues to prevent misunderstandings
and inappropriate relationships. Violations of professional
boundaries may result in loss of employment and licensure
and civil action, depending on the severity of violation.
 • Principles to Protect the Therapeutic Nurse-Client
Relationship
 The nurse’s responsibility is to delineate and maintain
boundaries.
 The nurse should work within the therapeutic relationship.
 The nurse should examine any boundary crossing, be aware
of its potential implications and avoid repeated crossings.
 Actions that overstep established boundaries to meet the
needs of the nurse are boundary violations.
 The nurse should avoid situations where he or she has a
personal or business relationship with the patient.
 Post-termination relationships are complex because the
patient may need additional services. It may be difficult
to determine when the nurse–patient relationship is
completely terminated.
 Be careful about personal relationships with patients who
might continue to need nursing services (such as those
with mental health issues or oncology patients).