Professional Boundaries in Nursing Practice Workbook · Although the information in the document...

IMPORTANT

As of Sept. 4, 2018, the following nursing colleges amalgamated to become

the British Columbia College of Nursing Professionals (BCCNP):

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• College of Registered Psychiatric Nurses of British Columbia (CRPNBC)

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Professional Boundaries in Nursing Practice Workbook

2855 Arbutus StreetVancouver, BCCanada V6J 3Y8

College of Registered Nurses of British Columbia

Tel: 604.736.7331Tol: 1.800.565.6505 (BC)Web: www.crnbc.ca

Introduction

ThisworkbookoffersactivitiesthatallowyoutoapplyideaspresentedintheModule.Itisorganizedinthreesections.

• Part 1 includesWorkbook Activities thatarerelatedtovarioustopicareas.Asyouworkthroughthemodule,youwillbedirectedtocompleteaspecificWorkbookActivity.Thissectionalsoincludespagesforyoutorecordyourreflectivethoughtsandinsightsrelatedtoyourexplorationinthismodule.

• Part 2, “Applying My Learning”,includesacasescenarioandassociatedquestions.Completingthisactivityprovidesanopportunityforyoutoapplyalloftheinformationthathasbeenofferedinthemoduleinthecontextofthispractice-basedscenario.Whenyouhavecompletedthiscase,youmaywishtocompareyourresponseswiththoseprovidedinthe“ApplyingmyLearning:Perspectives”locatedinPart3.

• Part 3 presentssample responses toWorkbookactivitiesandthecasescenarioinPart2.Theseresponsesprovidetheperspectivesofthecoursewriterandothersonthecasescenario.

page 2professional boundaries in nursing practice workbook

Part 1: Workbook Activities

WorkbookActivity#1


Considerthefollowingquestions.Recordyourresponsesinthespacesbelow.Thesethoughts,ideas,andresponseswillhelpyoudecidewhatyouwouldliketofocusoninthismodule.Theymayalsoformpartofthebasisforyourprofessionaldevelopmentplanningaspartofyourqualityassurancerequirements.

• Whataremystrengthsinrelationtotherapeuticrelationshipsandprofessionalboundaries?

• WhataspectsoftherapeuticrelationshipsandprofessionalboundarieswouldIliketoknowmoreabout?

• AmIawareoftheresourcesavailablethatcansupportmypracticeinrelationtotherapeuticrelationshipsandprofessionalboundaries?

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professional boundaries in nursing practice workbook

WorkbookActivity#2

1. Thinkbacktothecasescenario,andpretendyouareSaira.Wouldyoudothesamethingshedid(purchasingatoyforAnnie)?Whyorwhynot?Ifnot,whatwouldyoudo?Whatcontextualfactorsfromthescenarioareinfluencingyourchoicesanddecisions?Writeyourthoughtsinthespaceprovided.YoumaywishtocompareyouranswerswiththediscussioninPart #3, Perspectivesattheendofthismodule.

2. Reflection Point

Thinkofatimeinyourownpracticewhereyoumadeadecisioninrelationtoprofessionalboundaries.Itcouldbeanything….youmayhavedecidedtotakeextratimewithaclient,decidedtogiveaclientorfamilymemberahug;youmayhavehadaFacebookfriendrequestfromaclientorfamilymemberoryoumayhaveconsidereddoingapersonalfavourtohelpaclient,etc.Onceyouhavethoughtofscenario,thinkaboutthecontextualfactorsthatinfluencedyourthoughts,decisions,andactions.Wouldyouhavemadedifferentdecisions,ordonethingsdifferentlyifcircumstances,orthecontext,weredifferent?Howdidthecontextinfluenceyou?Recordyourthoughtsonthe“ThoughtsfromReflectionPoints”pageofthisworkbook.Atthecompletionofthemodule,youwillhaveanopportunitytousetheinsightsandaffirmationsgainedinvariouslearningactivities,aspartofyourplanningforfutureprofessionalgrowthanddevelopment.

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WorkbookActivity#3

Inthisactivityyouwillexplorethedirectionprovidedwithinyourprofessionalregulatorybody’swebsiteresourcesforestablishingandmaintainingprofessionalboundariesinnursingpractice.Thedocumentsandresourcescanbeaccessedfromtherelevantlinksbelow.

1. ReviewtheProfessionalStandardsforyourprofessionalgroup,forexample,RegisteredNursesandNursePractitioners.Asyoureviewthestandardsandassociatedindicators,considerhowtheyrelatetoyouruseofprofessionalboundariesintherapeuticrelationships.

Inwhatwaysdothestandardsandindicatorsprovidedirectionforcompetencyrelatedtoprofessionalboundarymaintenanceinnursingpractice?WriteyouranswersdowninyourWorkbook.

2. Theprofessionalregulatorybodywebsiteshavemanydifferentresourcesavailableregardingprofessionalboundariesinnursingpractice.TakesometimetoexplorethewebsiteofyourCollegeandfindwhatotherresourcesthewebsiteprovides.ListtheseresourcesinyourWorkbook.Youmaywishtoexploretheseresourcesinmoredetaileitherinthefuture,orrightnow.

3. TheCanadianNursesAssociationprovidessomedirectionforprofessionalboundariesintheCodeofEthicsforNurses.Pleasetakesometimetoinvestigatewhatdirectionthisresourceprovidesforyouintermsofprofessionalboundaries.Youmaywishtojotdownsomethoughtsandideasthisresourceprovidesforyou.AlinktothiswebsiteandmanyotherrelevantresourcesmaybefoundbyclickingonthelinktothemoduleResourceSectionbelow.

BC College of Nursing Professionals Web Site: https://www.bccnp.ca/Pages/Default.aspx

Standards Web Page:https://www.bccnp.ca/Standards/Pages/Default.aspx

Module Resource Section pdf: https://www.bccnp.ca/PracticeSupport/RN_NP/Documents/PBLearningResources.pdf

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https://www.bccnp.ca/Pages/Default.aspx

https://www.bccnp.ca/Standards/Pages/Default.aspx

https://www.bccnp.ca/PracticeSupport/RN_NP/Documents/PBLearningResources.pdf


WorkbookActivity#4

GotothewebsiteforyourRegulatoryBodyandreviewtheBoundariesintheNurse-ClientRelationshipPracticeStandard.Alinktoapdfofthisdocumentisalsoavailablebelow.Answerthefollowingquestionsinyourworkbook.Remember,youdonotneedtoshareyouranswerswithanyone.ThisexerciseisintendedtoassistyoutobecomeawareofhowyouutilizethePracticeStandardPrinciplesforboundariesinthenurse-clientrelationshipinyourpractice,andidentifyanyareasforfurtherlearningandgrowthinyourpractice.

https://www.bccnp.ca/Standards/RN_NP/PracticeStandards/Lists/GeneralResources/RN_NP_PS_Boundaries.pdf

1. HowfamiliaramIwiththePracticeStandardPrinciplesforBoundariesintheNurse-ClientRelationship?DoIregularlyindependentlyapplytheprinciplestomypractice?How?Ifnot,whynot?Writethesethoughtsdowninthespacebelow

2. Dotheseprinciplesofferinsightsorsolutionsforareasofprofessionalboundariesthatyouareunsureoforfindchallenging?How?

3. WhatisbestpracticeifaclientasksifI’veeverhadthesametypeofmedicaltreatmentheorsheisabouttoreceive?

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WorkbookActivity#4(continued)

4. Doesmyagencyhaveapolicyaboutreceivinggiftsfromclients?WherecanIfindthispolicy?AmIfamiliarwithit?

5. WhatshouldIdoifmychild’sfriendbecomesmyclient?

6. MyclienthasaskedifIwillcareforhim/herprivately,outsidemyagency’ssetting.Whatdirectiondoesthepracticestandardprovideinmakingthisdecision?

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WorkbookActivity#5

Eachagencyandemployermayhavedifferentpoliciesregardingnurses’practiceinrelationtoprofessionalboundariesinnurse-clientrelationships.Thisactivitywilldirectyoutofamiliarizeyourselfwiththespecificemployerpolicieswithinyourpracticesettingandhowtheseguide/restrictyourpracticeinrelationtoprofessionalboundaries.Recordthesebelow.

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WorkbookActivity#6

Reflectonyourownpracticeintermsofrecognizing,establishing,andmaintainingboundariesinnurse-clientrelationships.Hereyouareconsideringtheindividualnurselevelofcontrolonpractice.Whatknowledge,skills,judgement,andattitudesdoyouholdthatmayaffectyourpracticeinthisrealm?Writetheseideasdown.

Consider:WhatdoIneedtofindout,ordo,inordertoaddressanygaps?Thinkbroadlywhileyoudothis,andremember,youdonotneedtosharethiswithanybody!Thislearningactivitywillformpartofyourongoingprofessionaldevelopmentplan

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WorkbookActivity#7

Mostnurseswhoviolateprofessionalboundariesdonotintendtodoso,butendupinasituationwheretheirviolationpotentialishigh,andtheyenduptravellingdowntheSlipperySlope.ConsiderLesley’s storyandanswerthefollowingquestions.YoumaywishtocompareyouranswerswiththediscussioninPart #3, Perspectives at the end of this Workbook.

1. IdentifythefactorsthatcontributedtoLesley’sViolationPotentialinthissituation.Considervulnerability,riskfactors,andcontextinyouranswer.

2. LookingbackatLesley’sstoryagain,traceherpathdowntheslopetoboundaryviolation.Atwhatpointsdidsheengageinboundarydrift,boundarycrossing,andboundaryviolation?

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WorkbookActivity#8

Ifyouareworkingwithacolleaguewhomyoubelieveiscrossingorviolatingaprofessionalboundaryyouhavearesponsibilitytotakeaction.ConsiderSimone’s situationandanswerthefollowingquestions.YoumaywishtocompareyouranswerswiththediscussioninPart #3, Perspectives at the end of this Workbook.

1. ReferbacktotheBoundariesintheNurse-ClientRelationshipPracticeStandardandapplythePrinciplestoSimone’ssituation.WhatguidancedoesthePracticeStandardgiveforSimone?


2. ListtheactionsSimoneshouldtakeinthesituation.

3. Findouttheprocedureinyouragencyfordealingwithaboundaryviolationbyacolleague.Ifthereisnowrittenpolicy,youmayneedtohaveaconversationwithyourmanagerinordertofindoutyour’agency’sapproach.

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WorkbookActivity#9

Case One:

DoyourememberDaniel’s story fromearlierinthelearningmodule?Refreshyourselfonhissituationandthenusethethinkingtooltohelphimdecidewhattodobyansweringthefollowingquestions.Onceyouaredone,youmaywishtocompareyouranswerswiththediscussioninPart #3, Perspectives at the end of this Workbook.

Daniel is the charge nurse of the emergency room in a small rural community. He is also well-known in the community as he coaches his children’s sports teams and through other community events. Daniel also plays recreational hockey on a local team. During one shift, one of Daniel’s hockey teammates, who also happens to be one of Daniel’s son’s high school teachers, arrives in the ER with a small laceration that requires sutures. Daniel’s son has applied for a big scholarship, and this teacher is on the application review committee. The ER is extremely busy and the teammate will need to wait a long time to have this done. The teammate asks for his friend, Daniel, to fast track him so that he can get his injury attended to faster.

1. Ask,“WHOwillbenefitfromthisaction”?IfDanielfast-trackshisteammateandson’shighschoolteacher,whobenefits?

Ask,“WHOSEneedswillbemet?”Willtheclient’sneedsbemet?WillDaniel’s?Willtheneedsofotherclientsbemet?

2. Ask,“WHY? Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfDanielfasttrackshisteammate,willthishelporhinderthenurse-clientrelationship?How?

3. Ask,“WHAT?Isthisactionconsistentwiththeclientcareplan?”Whatisthecareplanfortheclient?Doesitincludethisaspect?

4. Ask,“HOW?IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwiththeclient?”WouldDanielbecomfortablewithotherpeopleorcolleaguesknowinghefasttrackedtheclient?

5. IfyouwereDaniel,whatisyourdecision?Why?

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Case Two:

Let’stryanothercasescenario.HereyouwillmeetScott,anursewhoworksinarehabilitationcentre.Again,youmaywishtocompareyouranswerswiththediscussioninPart #3, Perspectives at the end of this Workbook.

Scott works in a spine rehabilitation centre with clients who have sustained serious spinal cord injuries. Most of Scott’s clients are in the rehabilitation centre for at least several weeks, and Scott and his colleagues often get to know the clients well. Scott is caring for Grant, a young lawyer who sustained a thoracic spinal injury in a snowboarding accident. Grant has always been a very athletic man, and has had a difficult time adjusting to his new disabilities. He is also an ardent hockey fan. Scott has many similar interests as Grant, and the two men have established a very effective rapport. Grant trusts Scott and responds well to his treatment and intervention regime with Scott as his caregiver. In conversation one day close to Grant’s discharge from the rehabilitation centre, Grant and Scott discover they are both fans of the same local hockey team. Scott expresses regret about being unable to attend any of the team’s playoff games due to other financial priorities. At discharge, Grant gives Scott an envelope addressed to him. Inside is a handwritten thank you note and a pair of hockey tickets to the local team’s playoff games.

1. Ask,“WHOwillbenefitfromthisaction”?IfScottacceptsGrant’sgift,whobenefits?

Ask,“WHOSEneedswillbemet?”WillGrant’sneedsbemet?WillScott’sneedsbemet?

2. Ask,“WHY?Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfScottacceptsthetickets,willthishelporhinderthenurse-clientrelationship?How?

3. Ask,“WHAT?Isthisactionconsistentwiththenursingcareplan?”WhatisthecareplanforGrant?

4. Ask,“HOW? IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwiththeclient?”WouldScottbecomfortablewithotherpeopleorcolleaguesknowinghehadbeengivenexpensivehockeyticketsbyaclient?

5. IfyouwereScott,whatisyourdecision?Why?WouldyourdecisionhavebeendifferentifGranthadgivenScotttheticketsduringhishospitalization?Why?

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WorkbookActivity#10

Gothroughtheworkbookthatyouhavecompleted.Noticeareaswhereyouhavefurtherquestions,furtherinterest,orneedfurtherdevelopment.Noticeareaswhereyouhavestrengthsinrelationtoprofessionalboundarymaintenancetoo.Pickoneareathatyouwouldliketodevelopfurtherandcreatealearningplanforyoutomeetyourownlearningneeds.Youmayfindthefollowingframeworkhelpfulforyoutostructureyourlearningplan.AProfessionalDevelopmentPortfoliothatcanbecompletedelectronicallyisalsoavailableontheBCCNPQAWebpage.Alinktoapdfofthisdocumentisbelowandmakesurethatyousaveittoyourcomputertocompleteit

https://www.bccnp.ca/PracticeSupport/RN_NP/QA/Documents/387QAportfolio.pdf

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https://www.bccnp.ca/PracticeSupport/RN_NP/QA/Documents/387QAportfolio.pdf


MyPlanforGrowth

Goals

1.

2.

3.

Action PlanPeopleorplacesthatIcaninvestigateforlearningstrategiestohelpmemeetmygoalsforgrowthare:

1.

2.

3.


MyPlanforGrowth

Strategy Resources I need to implement this strategy

Target completion date Other thoughts

NotesfromReflectionPoints


ProfessionalBoundariesinmyNursingPractice:AffirmationsandInsights


Part 2: Applying My Learning


ApplyingMyLearning

Doyouwantmore?Inthissection,ApplyingMyLearning,thereisamorecomplexcasescenarioforyoutoworkthroughinordertofurtherintegrateandapplytheunderstandingyouhavebuiltthroughoutthemodule.Thissectionisoptionalforthosewhowantmorepracticeapplyingwhatyouhavelearnedtonursingpractice.

Case Study

PleasereadthefollowingcasescenarioaboutJanice,aRegisteredNursewhoworksinabonemarrowtransplantunit.Whenyouhavefinished,analyzethescenariousingtheinformationyouhavelearnedaboutinthismodule,andmakeadecisionaboutwhatJaniceshoulddo.Whenyouhavecompletedthisactivity,youmaywishtocompareyourresponseswiththoseprovidedinthe“Perspectives”sectionattheendofthisWorkbook.

Be sure to consider:• thetherapeuticnurse-clientrelationship

• thedirectivesforpracticeinrelationtoprofessionalboundaries

• theslopeofboundaryviolations

• violationpotential

• thethinkingtoolforprofessionalboundaries


ApplyingMyLearning

Janice cared for Mrs. Black, who was hospitalized on the bone marrow transplant unit following a transplant for her acute leukemia. Janice, who graduated from her nursing program 18 months ago, really enjoys working on the unit. She enjoys the acuity of care, but she particularly likes getting to know her clients and their families. She finds the work both challenging and rewarding.

Mrs. Black was a client on the unit for several weeks, and had experienced many downturns in her condition. In the periods of time when Mrs. Black’s condition stabilized, she talked frequently with Janice about wishing she would live long enough to see grandchildren born. Mrs. Black reminded Janice of her favorite aunt, Bonnie, and Janice developed a close, friendly relationship with her.

The frequent relapses in Mrs. Black’s condition made for a very tumultuous time for her close-knit family. Janice got to know all the family members quite well, including Mrs. Black’s 32 year old son, Hugh, who visited daily. Janice liked Hugh as he had a great sense of humor and Janice had an easy rapport with him. Hugh requested to be Facebook friends with Janice, and she accepted. Hugh would send websites and jokes he thought Janice would enjoy and Janice would occasionally do the same.

Eventually, Mrs. Black’s condition inevitably deteriorated and she ultimately passed away in the bone marrow transplant unit. Janice and two other nurses from the unit attended Mrs. Black’s funeral. Janice felt badly for the family members who had always been so hopeful about Mrs. Black’s condition. She let them know at the end of the funeral that she would be available to support them if they needed her.

A few weeks after the funeral Hugh contacts Janice and asks if she could meet him for coffee. Janice agrees, and she and Hugh have a nice conversation reminiscing about Hugh’s mother and generally catching up with each other. As Janice stands up to go, Hugh asks if he can have her telephone number; he’d like to ask her out for a date sometime, saying “Even my mom wanted me to ask you out!”. Janice blushes as her heart rate increases slightly….Hugh is very attractive, and she really enjoys his company.

Part 3: Workbook Activities and Case Perspectives


WorkbookActivity#2

ThereareanumberofcontextualfactorsthatareinfluencingSaira’sdecisioninthiscase.Herearesometoconsiderwhenyouanswerthisquestion.Youmayhaveotherideasaswell.

Context: • Whataretherules,regulations,policies,standards,andguidelinesthatgovernmypracticeinrelationtoprofessionalboundaries?What,ifany,aretheexceptionstothese?

• Whatismyunit’spolicyongifts?Whatismyunit’spolicyonclients’birthdays?

• Howdoesthisfitwiththeclientcareplan?

• WouldIhavemymanager’ssupportforthedecisionImake?

• ArethereothercolleaguesorpeopleIshouldinvolveinthisdecision?

• Howwouldtheclientfeelaboutmyaction?Howwouldherfamilyfeelaboutit?

• WouldIdothisforalltheunitclients?

• HowcomfortableamIwiththevariousoptions?Whataremybeliefsabouteach?

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WorkbookActivity#7

ConsiderLesley’s storyandanswerthefollowingquestions

1. IdentifythefactorsthatcontributedtoLesley’sViolationPotentialinthissituation.Considervulnerability,riskfactors,andcontextinyouranswer.

FactorsthatcontributedtoLesley’sViolationPotentialinthissituationinclude:• Vulnerability:Lesley’sclient’shusbandisinavulnerablepositionasheiscopingwithhiswife’sillnessaswellashischildren,job,andotherresponsibilities

• Context:Lesleyhasworkedwiththeclientandclient’shusbandoveralongperiodoftimeandhascometoknowthemwellviaacontinuouscaringrelationship.

• Catalyst:Lesleyexperiencesadivorce,whichincreaseshervulnerability.

2. LookingbackatLesley’sstoryagain,traceherpathdowntheSlipperySlopetoboundaryviolation.Atwhatpointsdidsheengageinboundarydrift,boundarycrossing,boundaryviolation?

Boundarydriftandcrossings:• Developingafriendshipovertime

• Havingcoffeetogether,sharingphotosofkids,talkingaboutoutsidelifeandotherthings

Theseactivitieswerecrossingfromtheprofessionalrealmintothepersonalrealm.Theseactivitieswouldnotbeapartoftheprofessionalnurse’srole,theclient’scareplan,and/orthenurse’sworktime.LesleyshouldhaverotatedclientassignmentswhenshefoundherselfwantingtospendmoretimewithLuke.

• Unableto“copewithalltheemotionandstress”onherown,andprogressingtoseeingtheclient’shusbandromantically.Thisisaclearboundaryviolation.

Lesleyneedstoseekoutanddeveloppersonalsupportnetworks.Shemayconsideremployeeassistanceprogramsofferedbyheremployer.

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WorkbookActivity#8

ConsiderSimone’ssituationandanswerthefollowingquestions

1. ReferbacktotheBoundariesintheNurse-ClientRelationshipPracticeStandard,andapplythePrinciplestoSimone’ssituation.WhatguidancedoesthePracticeStandardgiveforSimone?

Guidance from the Practice Standard includes:• Thenurse-clientrelationshipisconductedwithinboundariesthatseparateprofessionaltherapeuticbehaviourfromnon-professionalandnon-therapeuticbehaviour.

Simoneiswitnessingbehaviourthatmakesherfeeluncomfortable,becauseshebelievesitisnon-therapeutic.

• Thenurse,nottheclient,isalwaysresponsibleforestablishingandmaintainingboundaries.

Geoffisresponsiblefortheestablishmentandmaintenanceofprofessionalboundarieswiththeclient.

• Nursesdonotenterintoafriendshipwithclients

Simoneiswitnessingbehaviourthatisexpectedwithinnon-professional,friendlyrelationships,butnotinthecontextofaprofessionalrelationship.

• Nurseshelpcolleaguestomaintainprofessionalboundariesandreportevidenceofboundaryviolationstotheappropriateperson.

SimonemusthelpGeofftore-establishprofessionalboundaries;thismayincludejustashort,factualconversationwithGeoffregardingthePracticeStandard,and/oritmayincludereportinghisbehaviourtotheirmanager.

• Employersthatprovideeducation,supervision,andsupportrelatedboundaryissueswillhelpstaffrecognizeandresolveproblemsintheearlystagesSimonemayinvolvehermanagertohelpresolvetheissuebeforeitbecomesabiggerproblem.

• Considerifaspectsforthenurse’srelationshipwiththeclientarehiddenfromothers,thenursedoesnotwantothernursestohavethesamerelationshipwiththeclient,thenurseisgivingpreferentialcareortimetotheclient.

Geoffisgivingpreferentialcareandtimetothisclient

2. ListtheactionsSimoneshouldtakeinthesituation.

TheRegulatoryBody’swebsitesprovidespecificguidanceandresourceswhichcanhelpSimoneinthis situation.AnexampleisawebmoduleontheBCCNPwebsiteentitles“TakingActiononConcernsAbout Practice”.https://www.bccnp.ca/Lists/Flash%20Modules/Taking_action/player.html

SimonecanalsotalktoamanageroraccessthepracticeconsultationandadvisingserviceofherRegulatory Bodytohelpguideheractions.

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https://www.bccnp.ca/Lists/Flash%20Modules/Taking_action/player.html


WorkbookActivity#9

Case One: Daniel’s Story

1. Ask,“WHOwillbenefitfromthisaction”?IfDanielfast-trackshisteammateandson’shighschoolteacher,whobenefits?

• IfDaniel’sfast-trackshisteammate/son’shighschoolteacher,theteacherwillbenefit.However,Danielandhissonmayalsopotentiallybenefitfrompossiblepreferentialtreatmentofhisson’sscholarshipapplication.

Ask,“WHOSEneedswillbemet?”Willtheclient’sneedsbemet?WillDaniel’s?Willtheneedsofotherclientsbemet?

• Theclient’sneedswillbemet,andDaniel’spersonal(notprofessional)needsmaybemet.However,thiswilloccurattheexpenseofotherclients’needs,sinceDanielwillnotbefollowingstandardizestriageassessmentprotocols.

2. Ask,“WHY?Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfDanielfasttrackshisteammate,willthishelporhinderthenurse-clientrelationship?How?

• IfDanielfast-tracksthisclient,hewillalsobeviolatingaboundaryintermsofbehaviourrelatedtofavoritism.Thiswillhinderthenurse-clientrelationship.

3. Ask,“WHAT?Isthisactionconsistentwiththeclientcareplan?”Whatisthecareplanfortheclient?Doesitincludethisaspect?

• Thisactionisnotconsistentwiththisclient’scareplan,sincehedoesnotrequirefast-trackingaccordingtotriageprotocols.Thisactionisalsonotconsistentwithotherclients’careplans.

4. Ask,“HOW?IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwiththeclient?”WouldDanielbecomfortablewithotherpeopleorcolleaguesknowinghefasttrackedtheclient?

• Danielwouldneedtoanswerthisquestionforhimself,however,wouldyoufeelcomfortableifotherpeopleandcolleaguesknewyouhadfasttrackedthisclient(ifyouwereDaniel)?

5. IfyouwereDaniel,whatisyourdecision?Why?• Danielshouldideallytransferthecareofhisfriendtoanothernurse(Principle#8BoundariesinNurse-

ClientRelationshipPracticeStandard).Ifthisisnotpossible,Danielneedstoclarifythatheisactinginaprofessionalcapacityandnotapersonalcapacitywithhisfriend(Principles#9and#10BoundariesinNurse-ClientRelationshipPracticeStandard).Danielmayneedtoinvolvehismanager.

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Case Two: Scott’s Story

1. Ask,“WHOwillbenefitfromthisaction”?IfScottacceptsGrant’sgift,whobenefits?• Scottwilldirectlybenefitfromthisaction.

Ask,“WHOSE needswillbemet?”WillGrant’sneedsbemet?WillScott’sneedsbemet?• Scott’sneedswillbemet.

2. Ask,“WHY? Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfScottacceptsthetickets,willthishelporhinderthenurse-clientrelationship?How?

• Acceptingtheticketswillnotcontributetothetherapeuticnurse-clientrelationship.

3. Ask,“WHAT?Isthisactionconsistentwiththeclientcareplan?”WhatisthecareplanforGrant?

• Grantisbeingdischarged,however,acceptingtheticketswouldnotbeapartoftheplanofcareforGrant.

4. Ask,“HOW?IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwiththeclient?”WouldScottbecomfortablewithotherpeopleorcolleaguesknowinghehadbeengivenexpensivehockeyticketsbyaclient?

• Scottwouldneedtoanswerthisquestionforhimself,however,wouldyoufeelcomfortableifotherpeopleandcolleaguesknewyouhadacceptedthesetickets(ifyouwereScott)?

5. IfyouwereScott,whatisyourdecision?Why?WouldyourdecisionhavebeendifferentifGranthadgivenScotttheticketsduringhishospitalization?Why?

• ScottneedstoexplaintoGrantthatheisunabletoacceptthesignificantgift,althoughhetrulyappreciatesthegesture.Hecannotacceptthem,butifGrantisinsistent,ScottcouldsuggestthatGrantspeaktothemanageraboutit.Theremaybespecificagencypolicyinplaceregardingsubstantialgifts;forexample,agencypolicymayallowforsomethinglikeastaffdraw(Principle#17BoundariesinNurse-ClientRelationshipPracticeStandard).

• ThedecisionwouldnotbedifferentiftheticketswereofferedduringGrant’shospitalization.Scottcoulddiscusstheissuewithhismanagerandcolleaguestoensurethatthereisaconsistentunderstandingofprofessionalresponsibilitiesandagencypolicy:Giventhecontextofrehabilitation,andthelongtermnatureofthenurse-clientrelationships,itmaybeanticipatedthatthistypeofsituationmayariseagain.

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CasePerspectives

Trust: Trustiscriticalinthenurse-clientrelationshipbecausetheclientisinavulnerableposition.HughtrustedJanicetocareprofessionally,ethically,andcompetentlyforhismother.Hismotherwasinavulnerableposition,andHughistoo.DatingHughwouldtakeadvantageofthisvulnerability.

Respect: Respectistherecognitionoftheinherentworth,dignity,anduniquenessofeachindividual.Atthispoint,respectseemstobeintactwithinthisnurse-clientrelationship.

Professional intimacy: Professionalintimacyincludesphysicalactivitiesthatcreatecloseness(forexample,bathing,andalsopsychological,spiritual,andsocialaspectsofcare.Janice’srelationshipwithHughhasasenseofintimacyfromaprofessionalstandpointbecauseoftheintimatecareshehasprovidedtohismotheraswellasthepsychosocialnursingcareshehasprovidedtoHugh.DatingHughwouldviolatetheprofessionalnatureofthisintimacy.

Empathy:Empathyallowsthenursetoprovidecompassionateandethicalcaretoclientsandfamilies.Empathy,however,alsoincludeappropriateemotionaldistancefromtheclienttoensureobjectivityandanappropriateprofessionalresponse.ThisemotionaldistancewillbenegatedifJanicedatesHugh.

Power: Thenursehasmorepowerthantheclientinthenurse-clientrelationship.JaniceandHugharenotonequalfooting.

Levels of Control on Practice:TheBoundariesintheNurse-ClientRelationshipPracticeStandardprovidesdirectionforJanice’spractice.Principles#1,#3,#5,#6applyhere.https://www.bccnp.ca/Standards/RN_NP/PracticeStandards/Pages/boundaries.aspx

Violation Potential:Janice’sviolationpotentialwasmostlyimpactedbythecontextofcaringforaclientoveraperiodoftime,inemotionallychargedcircumstances.ThecatalystherewasMrs.Black’sdeath.

Slippery Slope:Janicestarteddowntheslipperyslopewithoutmeaningto.Boundarycrossingsoftenstartoffasinnocuous.Janicebegantocrossboundarieswhenshe:- beganthinkingofMrs.Blackasheraunt- developedaclose,friendlyrelationshipwithher- acceptedFacebookfriendshipwithHugh- sharedjokesandwebsiteswithHugh- offeredtobeavailabletosupportthemiftheyneededher

https://www.bccnp.ca/Standards/RN_NP/PracticeStandards/Pages/boundaries.aspx


CasePerspectives

Thinking Tool

Who? IfJanicegoesoutwithHugh,Janicebenefits.

Whoseneedsarebeingmet?Janice’ssocialneedsarebeingmetifshedatesHugh.

Why? Doesthishelporhinderthetherapeuticnurse-clientrelationship?Asnotedinthediscussionearlier,Janicerisksalteringthetherapeuticnurse-clientrelationshipsothattheclient’sneeds(Hugh’sneedsarenolongerinthecentreofsafe,appropriate,competentandethicalclientcare.

What? JanicedatingHughisnotconsistentwiththeclientorfamilycareplan.

How?WouldJanicebecomfortablewithcolleaguesandothersknowingshewasdatingHugh?

JaniceneedstorespectfullydeclineHugh’sinvitation,andre-establishaprofessionalrelationship.JanicemaywishtoinvestigateBCCNPresourcestohelpherwiththisaction,orpossiblydiscussthesituationwithhermanager.Thismaybeanopportunitytoinitiatesomediscussionandsharedlearningwithcolleaguesaboutprofessionalboundaries.

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