The nurse-client relationship is the foundation of nursing practice across all populations and cultures and in all practice settings.
The nurse relationship with the patient/client is one built on trust and respect. Nurses generally have the balance of power in this relationship as the patient is quite often at their most vulnerable. Nurses have access to confidential and private information about the patient and have knowledge and skills which can be used to influence care decisions.
Therapeutic communication and establishment of therapeutic realationships are core elements of nursing practise and nurse training. The intent of the relationship is to help the patient overcome barriers in meeting their unmet needs. Stepping outside this helpful role is where the nurse is most at risk of unprofessional conduct.
Professional boundries are guidelines for maintaining a positive and helpful relationship with our clients or residents. Understanding boundries helps care givers avoid stress and mis conduct, recognise boundary crossings and provide the best possible care.
Professional Boundries for Caregivers Manual
The literature conceptualises professional boundries as the Zone of Helpfulness model and also as a Continuum of Professional Behaviour. Each model includes both ends of the extreme being under involment and over involvement. Most transgressions of professional boundries are said to be due to over involvement.
Signs of over involment can be from the obscure to the very obvious. Below are some signs for nurses to look for in themselves and in their colleagues.
- spending an inappropriate amount of time with a patient/client
- visiting the patient when off duty
- swapping allocations to be with a patient/client
- thinking you/they are the only ones who truly understands the patients/clients needs
- having/holding secrets with the patient/client
- over sharing of own personal information and circumstances
- reacting/overacting emotionally to patient behaviour
- giving or receiving gifts or giving special favours
- giving advise outside own skills, expertise and scope of practise
Boundry crossings can at times be intentional in an effort to gain engagement of the patient. In these instances a question the nurse needs to ask is “would I feel comfortable if others were fully aware of what I have done”. Professional boundries are crossed every day mostly unintentionally. In most instances nurses are not aware that they are in danger of crossing over into unprofessional conduct.
Regular dissemination of information and in-services is one strategy of raising nurses awareness. Interactive education sessions would be most beneficial providing nurses with an opportunity to clarify and explore from own personal and hypothetical incidences.
Whose role is it to ensure, guide, mandate or provide awareness raising education to and for nurses. AHPRA is the governing registering body in Australia for most health professions which includes Nursing. AHPRA does provide fact sheets and standards about professional conduct for nurses.
A question that should be asked is what more should AHPRA be doing in this space. Is it more appropriately the role of employers of nurses or is it the responsibility of individual nurses to ensure nurses are aware and responsible for professional behaviour.